2003 STUDENT CONTESTS ENTRY FORM

Please complete all blanks:

Your Name:   Address:   (Address Cont'd:)   Home Phone   Grade   Poetry Teacher's Name: (First and last names.)   Name of School:   School Address:   (Address Cont'd:)   CONTESTS ENTERED Enter the # of poems submitted to each contest. ___ Homer Henderson ___ Betty Fukuyama ___ Tom Erdmann Totem ___ Bart Baxter FEES ___ I am entering one only (free) ___ I am entering ___ additional poems at $5 entry fee for each contest entered with one to five poems. Homer   $ ______ Betty   $ ______ Tom   $ ______ Bart   $ ______ I wish to become a member of WPA; enclose $10 membership fee   $ ______ (Checks payable to: Washington Poets Association)   Total:   $ ______

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