YOU MUST PRINT THIS PAGE AND SEND IT WITH YOUR FEE!
Make personal checks/money orders payable to: Amy 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 Entries To:
Amy M Hess
Attn: TPS E.C.
PO Box 15
Worthington, WV 26591
Address: ___________________________________________________________________
City: ____________________________________ State: ______ Zip Code:__________
Country: ____________________________________
E-mail: __________________________________________________________________
Number Of Poems Submitted: ____________
Total Amount Enclosed: $ _______________ ($1.00 Per Poem)
Method Of Payment (X):
Money Order: __________ Personal Check: ___________ Cash: _________
(Payable to Amy Hess)
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: June 1, 2010