Contest Submission Form
Name
Birth Date
Address
School Attended
City
Grade Completed (As of June 2012)
Postal Code
Phone
Title of Submission
Poem
Short Story
Upload Your Document
"I confirm that this entry meets the rules and regulations as stated on the reverse and is an original literary work of my own/my child's creation, and I consent to the release of personal information and the submitted work for publicity and publishing purposes only."
If you are between the ages of 12 and 15 you must fill in the name of your parent or guardian which signifies their approval.
Student's Name (16 - 18 years)
Parent's Name (12 - 15 years)
