Poetry Roadshow 2006 Application Form
Applicant Information
Name:
_____________________________________________________________________________
Address:  home work
_____________________________________________________________________________
_____________________________________________________________________________
Phone (work): _______________________ Phone (home): ______________________
I prefer to be contacted at my home work telephone number
Email: _________________________________________________________________
References
Please provide the names and phone numbers of three references who can attest to your abilities.
Name: ________________________________ Phone: _______________________
Name: ________________________________ Phone: _______________________
Name: ________________________________ Phone: _______________________
Completed application materials must be postmarked no later than September 29, 2006 and submitted to:
2006 Poetry Roadshow
c/o Ed Stover
3506 W. Chestnut Avenue
Yakima, WA 98902
The 2006 Poetry Roadshow is made possible through the generosity of Humanities Washington and the National Endowment for the Humanities.
|
