______________________________________________
(Title)
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
Poems can also be submitted on a separate page and attached.
Be sure to fill out the form below for each submission.
Poet Information & Release Form
| Poet's Name: |
_________________________ |
| Age: |
_________________________ |
| Address: |
_________________________
_________________________ |
| Tel No. |
_________________________ |
| Contact Person Name: |
_________________________ |
| Tel No. |
_________________________ |
| If you wish to be listed as anonymous in publications, check here: ________
|
By signing below, I understand that I am giving The AIDS Poetry Project unlimited
rights to reproduce the above or attached poem in any print or electronic media form.
Parent/Guardian's signature:
(for children under 18) |
_________________________ |
Poet's signature:
(for people 18 and over) |
_________________________ |
This article was provided by AIDS Poetry Project.
