National Media Award Entry Form

Introduction
Welcome to the entry form for SAVE's National Media Award for Excellence in Reporting on Suicide. Please complete this form in it's entirety. Incomplete forms will not be eligible for judging. If you have any questions about your entry or this form, please contact the Program Manager at save@save.org. Please be sure to read fully the Official Award Entry Rules and Regulations before getting started (www.save.org/mediaaward).
Please verify your age.*
- I am 18 years of age or older.
- I am 17 years of age AND have completed the Minor Applicant Participation Form.
If you are 17, you will upload your completed Minor Applicant Participation Form next. To download and complete this form, go to www.save.org/mediaaward.
If applicable, upload the completed Minor Applicant Participation Form.

Entrant Information
I am applying as...
- An individual
- A group (collaboration)
- A media organization
If applying as a group or media organization, please select a primary contact to complete the entry.
Name*
First Last
Name of media organization*
Email*
Phone*
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

If you win, this address will be used to send the award.

Upload Your Entry
Upload PRINT or ONLINE PDFs here.
Accepted file types: pdf.
You may also submit a live link to the publication, but it is not required if you choose to upload a copy.
Copy and paste URL where judges can view your publication or broadcast.
If submitting a URL for a publication, you may want to also consider uploading a PDF in the event your article is removed from a live URL.
If your broadcast or online publication is listed as private, please include any login information necessary to access your entry.
Login Password
If your publication or broadcast is in another language, please upload an English translation here (PDF format only, please).
Accepted file types: pdf.
Publication Information
Date your entry was first published or broadcast.*
Please list the name(s) of the media organization(s), network(s) or station(s) that published or that broadcast your entry.*
Attach any letters of complaint, corrections or retractions that are relevant to the judging process.
PDF only.

Confirmation of Entry
I hereby certify and represent that I have read the Official Award Entry Rules and Regulations and fully understand the meaning and effect thereof and, intending to be legally bound, I submit this entry.*
- Yes
Electronic Signature- Please type full legal name.*
Today's date*

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