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Write poems of any length in the space provided below or add
extra sheets.
You may submit as many entries as you want. An entry fee/donation
must
must be submitted with each entry. Also you may enter as many
of the contests
as you want to enter and submit an entry fee/donation with each
entry
by the deadline for that contest ”Theme“. Poems
may be typed or handwritten.
Please write legibly.
Contest #________Contest Theme _________________________________
Contest Deadline Date____________________________________________
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ENTRANT INFORMATION
NAME:_______________________________________
ADDRESS:___________________________________
____________________________________________
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CITY__________________________________________
STATE_________________________________________
ZIP CODE______________________________________
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COUNTRY____________________________________________
TELEPHONE:_(_____)__________________________
AGE:______
I have read and understood the rules and
regulations attached to this official entry form and
I agree to be bound by these rules and regulations and the decisions
of the judges.
I hereby assign any/all rights, title and interest, including
copyrights, I may have in the enclosed
poetry and writing to USANationals.Com and I consent to possible
publication of the poems and writing,
if selected as a winner, together with my name, age, and address,
without additional compensation
beyond the cash, prizes, awards and recognition to be given
to me for winning.
Signature of Entrant *
________________________________________________Date_________________
*Entry will be void without signature.
Signature of Parent or Guardian **
________________________________________________Date_________________
** If entrant is under 18 years of age, entry will be void without
Parent/Guardian's signature.
If paying by credit card you may submit on line or fill in
credit card information below and mail your entry.
Do Not mail in if you have submitted your entry, poem and fee/donation
on line.
Type of Card: Visa____ MasterCard____ Discover____
Card Number:__________________________________________
Expiration Date: ______________________
The credit card is in what name?: __________________________________________________
Signature: __________________________________________
$1.00 All ages Mini Contest to win cash and prizes up to $5,000.00
To go to on line credit card
payment entry form click here and enter for for $1.00,
Pay donation below to win cash and prizes up to $500,000.00
- $10.00 adults (18 years old and
older)
- $8.00 for Teens 11 to 17 years
old
- $5.00 for Youth 7 to 10 years
old
- $3.00 for Kids up to 6 years
old
If you are sending your entry and fee/donation by mail:
Send entries and an entry fee/donation for each entry in a stamped
envelope to:
Global Media & Communications, Inc.
385 Talbot Street, #7
Pacifica, CA 94044
USA
Make checks and Money Orders payable to:
Global Media
If you have questions about the contest, click here
to e-mail us at
shepppardalbert@yahoo.com
or call (650) 359-3324 |
