One entry per person. Submission form must be completed for entry into I Care, We Care Prize Drawing. Entries for children under the age of 18 must provide contact information and permission from a parent or guardian in the form below.

1. Your Name or Child's Name *
2. Contact Email Address *
3. County * —Please choose an option—Carson CityChurchillClarkDouglasElkoEsmereldaEurekaHumboldtLanderLincolnLyonMineralNyePershingStoreyWashoeWhite Pine
4. Prize Drawing Category * —Please choose an option—YouthAdult
5. Contact Telephone *

6. Choose either Image Care Message or Text Care Message

7. Image Care Message (Option One)

1. Text Care Message (Option Two)
2. I grant Nevada PEP permission to display my/my child's submission in the Community Care Gallery. I also agree to the Rules for the I Care, We Care Prize Drawing. * Yes