Greenburgh’s 42nd Annual Poetry Contest Application
(This form may be reproduced) Please PRINT the following information
1. Your name:
2. Your age (if under 19)
3. Personal identification number:
(any five digit/letter combination you like)
4. Street address: _________________________________________________
5. City, state & zip code) ____________________________________________
6. Telephone number ( )
7. Email address: @
8. Entry category: (circle one) ADULT STUDENT (13-18) JUVENILE (6-12)
9. Title of poem, # of lines: 1)
2)
10. Entry fee - check # ____________
11. In the space below, write a 30-word (maximum) self-description.
By your signature, you attest that the enclosed poetry is your original work and meets all rules for entry in this contest. If your poem reaches finalist status, you agree to submit an electronic copy and will allow its publication in the 2013 anthology, Let the Poets Speak.
_
Signature
___________________________________________
Date
