Video Contest Entry Form

First Name (required)

Last Name (required)

Email (required)

Age (required)

School (required)

City (required)

Adult Sponsor's Name (required)

Adult Sponsor's Email (required)

Name of Video (required)

Youtube Video Link (required)

How did you find out about the contest? (required)

Has anyone talked to you about the dangers of prescription drug abuse?

Yes

No

Names of Team Members