Application

Directions for submitting your ISMA entry:

1. Please review the guidelines for each category prior to filling out entry application below by clicking here.
2. Fill out the Entry Application below.
3. To submit your entry online, follow the instructions for attaching your media, then click the Submit button.
4. To submit your entry by mail, print the completed application form and mail it, along with your media (in the format described in the guidelines) to:
   
   Alaska Injury Prevention Center
   International Safety Media Awards
   Attn: Marcia Howell
   3701 E. Tudor, Suite # 105
   Anchorage, AK 99507
   USA
   

If you have questions or concerns, feel free to email Marcia Howell, at: Marcia.howell@alaska-ipc.org, or call her at +01-907-929-3939.

International Safety Media Award Entry Application
Contact Information
Organization:	*
Name of Contact Person:	*
Street:	*
City:	*
State:	*
Zipcode:	*
Country:	*
Phone:	*
Email:	*
Website:

Team Members

Please list the names of your team members:*

Entry Information: Fill in the blanks below for each entry For help submitting a video via YouTube, please click HERE
Title:	*
Injury Issue:	*
Describe Target Audience:	*
Category:	Print Audio Video/Ultra Short Video/Short New Media *
Campaign:	No Yes
Campaign Title:
Video Link:
Attach Entry:

Evaluation Narrative
Either describe the methodology and outcomes from the evaluation here, or attach a Word Document or .pdf describing the evaluation of the entry:*
Attach Evaluation Narrative:
* Denotes required field.