|Name: (include all the names you are called by)|
|Age: I am at the age where...|
|Physical Peculiarities:(the ones you are aware of)|
|Other Comments about yourself:|
|What you were doing at the time:|
|Who you were with:|
Note: By clicking on "Submit" You hereby agree to the following:
1. Your Report and fly sighting image may be displayed on a web page. Whether Your Report will be displayed or not shall be determined solely by Yoko Ono and ArtCommotion, Inc.
2. Your Report and fly sighting image may be utilized, free of charge, by Yoko Ono and ArtCommotion, Inc. in any advertising and publicity, catalogues, or other business activities relating to "Yoko Ono, One Woman Show" and ArtCommotion magazine.
3. You hereby represent and warrant that the Report and fly sighting image You submit is wholly original with, and owned by, You, and is not copied from any other work and is not, nor shall the use thereof, infringe or violate the copyright of any common law right or any personal, proprietary or other rights of any kind whatsoever of any person, firm, corporation or association. You shall indemnify and hold Yoko Ono, ArtCommotion, its successors, assigns, and licensees harmless from and against all claims, damages, liabilities, costs and expenses, including reasonable attorney's fees, arising out of the use of Your Report and fly sighting image, or arising out of any breach by You of any representation, warranty or agreement made by You herein.