PLEASE READ

Provide an Entry Title, select the number of participants, and complete all fields for each participant. Each participant must sign/date this Entry Form and obtain signature from an authorized representative as described in the Guidelines.
To print: Select "Print" button to the right or Select "File > Print" from your browser menu.
ImagiNations 2012 Design Competition Entry Form

Entry Title

Number of Participants:  2  3  4

Entry Deadline

Completed application must be postmarked by October 21, 2011. And must include resumes and proof of enrollment.

Participant #1 (Team Leader)

First Name: 

Last Name: 

Temporary or School Address: 

Apt # or Unit #: 

City:  State:  Zip: 

Permananet Address: 

Apt # or Unit #: 

City:  State:  Zip: 

Telephone #: 

E-mail: 

Major: 

 Junior  Senior  Graduate  /  Graduation Month/Year: 

University/Organization: 

Participant #2

First Name: 

Last Name: 

Temporary or School Address: 

Apt # or Unit #: 

City:  State:  Zip: 

Permananet Address: 

Apt # or Unit #: 

City:  State:  Zip: 

Telephone #: 

E-mail: 

Major: 

 Junior  Senior  Graduate  /  Graduation Month/Year: 

University/Organization: 

Participant #3

First Name: 

Last Name: 

Temporary or School Address: 

Apt # or Unit #: 

City:  State:  Zip: 

Permananet Address: 

Apt # or Unit #: 

City:  State:  Zip: 

Telephone #: 

E-mail: 

Major: 

 Junior  Senior  Graduate  /  Graduation Month/Year: 

University/Organization: 

Participant #4

First Name: 

Last Name: 

Temporary or School Address: 

Apt # or Unit #: 

City:  State:  Zip: 

Permananet Address: 

Apt # or Unit #: 

City:  State:  Zip: 

Telephone #: 

E-mail: 

Major: 

 Junior  Senior  Graduate  /  Graduation Month/Year: 

University/Organization: 

Signatures

Entries missing required signatures will not be considered for ImagiNations 2012.

In consideration for the opportunity to win an all-expenses-paid-trip to Walt Disney Imagineering, to be considered for an internship opportunity, the opportunity to win a cash prize and for the opportunity for the University or Association or Organization whose signature appears hereon to receive a $1,000 grant (to be split equally among the Universities, Associations and/or Organizations represented by the team) if our entry is adjudged the first place winner, I/we understand and agree that any and all submissions will become the sole property of Walt Disney Imagineering and will not be returned. All rights to use these ideas will be retained by Walt Disney Imagineering without expectation by me/us of other consideration. Any offer of an internship or other employment opportunity is expressly contingent on my/our eligibility for employment in the United States.

Participants Signatures evidencing agreement with the terms and conditions specifically contained herein and those of the overall ImagiNations 2012 Design Competition:

1.   Date: 

2.   Date: 

3.   Date: 

4.   Date: 

Mailing Address

Walt Disney Imagineering
Attn: ImagiNations Design Competition
1401 Flower Street MC 9030
Glendale, CA 91221-5020

Signature for one of the following:
Authorized Representative from University, Association or Organization

Signature evidencing agreement with the terms and conditions specifically contained herein and those of the overall ImagiNations 2012 Design Competition:

Representative(s) Signatures must sign for each participant and should include Printed Name, Signature, and Date:

Name  Date: 
Signature 

Name  Date: 
Signature 

Name  Date: 
Signature 

Name  Date: 
Signature 

(PLEASE LEAVE BLANK)

ENTRY #:

DATE RECEIVED BY WDI:

PLEASE READ

Provide an Entry Title, select the number of participants, and complete all fields for each participant. Each participant must sign/date this Entry Form and obtain signature from an authorized representative as described in the Guidelines.
To print: Select "Print" button to the right or Select "File > Print" from your browser menu.