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 Entries To: Amy Marie Hess The Poet Sanctuary Rt 2 Box 321 Fairmont, WV 26554
Full Name: ___________________________________________________________________ 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: _________ 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, 2008