Full Name: ___________________________________________________________________
Address: ___________________________________________________________________
City: ____________________________________ State: ______ Zip Code:__________
Country: ____________________________________
E-mail: __________________________________________________________________
Number Of Poems Submitted: ____________
Total Amount Enclosed: $ _______________ ($1.00 Per Poem)
(Remember, winner gets all entry fees as prize. Our mission is non-profit!)
Method Of Payment (X):
Money Order: __________ Cash: _________
(Payable to Lacey Hatmaker)
I certify that the poem(s) enclosed for The Poet Sanctuary Excellence Award Competition is/are my own
original work and that I am 13 years of age or older.
Signature: ___________________________________________________ Date: ___________________
Current Deadline: December 1, 2016
TPS Excellence Competition
1517 S Dakota Ave
Lakeland, FL 33803
USA
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