Nominate your Lions club or Leo club for a World of Service Award in the category of Best Reading
Action Program Rap Video by posting your video to YouTube and completing this form. E-mail this form
to firstname.lastname@example.org or fax it to 630-571-1685.
Your rap music video should be no longer than two minutes long and the subject must be about how to
get children to read. The rappers must be Lions and/or Leos. If your video includes children younger than
age 18, you must have video release forms signed by their parents/legal guardians and be able to provide
these documents upon request.
All videos must be submitted no later than March 1, 2013. Videos submitted without this form cannot be
accepted. Videos will be added to our official YouTube channel,
http://www.youtube.com/LionsRapContest, after Feb. 1, 2013.
The top winning video will be played during a plenary session at the international convention in Hamburg,
Germany, and the club will be recognized with an award. International directors will accept awards on
behalf of winners who cannot attend.
Rap Video YouTube URL _________________________________________________________________
Rap Video Title ________________________________________________________________________
Club Name ____________________________________________________________________________
Club Number _____________________________________Dist. _______________________________
Home Phone ________________________________________Work Phone________________________
Street Address (No P.O. boxes) ___________________________________________________________
I certify that all participants featured in this video are 18 years of age or older. If the video participants
are younger than 18, I have video release forms signed by their parents/legal guardians that I can
provide if required.
Signature ___________________________________ Date _____________________________________
Printed Name _________________________________________________________________________