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Safe Motherhood Initiative
Regional Safe Motherhood Photography Contest
 

Registration Form

We invite you to fill out the registration form taking into account the terms and conditions of the contest.

After answering the following questions, please click on the "Send" button below. All fields are required.

First and Last Name  

Date of Birth  

Address  

City  

State/Province/Department  

Country  

Telephone  

Email Address  

Títle of the Photograph  

Description of the Photograph (Location, Protagonists, Context, Relevance)  

I agree with the terms and conditions of the Safe Motherhood Photography Contest:

 Yes
 No
 

I took the attached photograph and have the rights to its use:

 Yes
 No

NOTE: The photograph must be sent as a high resolution image (between 180 and 300 dpi). Acceptable formats include jpg., gif., png., bmp., tif., and pdf.

   
 

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