STEP ONE

Click the YouTube Button to upload your contest entry video. Then return to fill out the form below.

STEP TWO

Please enter your contact information so we can reach you if your video is chosen.

First Name *

Last Name *

Address

City

State/Prov

Post/Zip

Country

Phone *

E-Mail *

Age *

Gender
Select - Male Female
Video URL


  * required fields

I have read and agree with the terms of the contest. That I am over the age of 18.

I have read and agree with the terms of the contest. That I am under the age of 18 and I have permission from a parent or guardian.

I have downloaded and agree with the terms of the release document.

Once you've uploaded your video, be sure to go to the Bon Jovi Loves My Town channel and vote on contest entries. Check back with the website and see who the pick of the day is. It might be you!