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YOU MUST PRINT THIS PAGE AND SEND IT WITH YOUR FEE! Make personal checks/money orders payable to: Amy Marie Hess Cash payments are accepted, but will be sent at your own risk. All payments must be in the form of US Dollars/Funds. Bounced/Returned checks will be subjected to a $10.00 fee. Mail Subscription Fee To: Amy Marie Hess Attn: Quill Brochure Rt 2 Box 321 Fairmont, WV 26554 |
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| Full Name: ___________________________________________________________________ Address: ___________________________________________________________________ City: _________________________________ State: ______ Zip Code _____________ Country: ____________________________________ E-mail: __________________________________________________________________ The Poet Sanctuary Quill Brochure Subscriptions (X): $2.50 Per Month or $27.50 Per Year Monthly: ________ 1 Year: _________ Total Amount Enclosed: $ _______________ Method Of Payment (X): Personal Check: ________ Money Order: _________ Cash: ________ Are you currently a registered member of The Poet Sanctuary? (Circle) Y N Would you like to have a poem featured in a future Quill Brochure? Send it in with your subscription fee! If your poem is selected, you'll receive $2.00 and a free Quill Brochure as payment for your work! |
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