Washington Poets Association

2003 STUDENT CONTESTS ENTRY FORM

MAIL TO: WPA Contests, c/o Ruth Rottinghaus, 495 Tanglewood, Richland, WA 99352.


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:	$ ______