"$250,000.00 USA Nationals.Com"
World's Richest Kids International Poetry Contest
Official Contest Entry Form
Please submit your entries with your entry fees/donation using this mail-in form.
If unable to print this page, please try the plain text version.
(right-click the link and choose 'save as' to save the file to your hard drive or click to open it and
then save it to your hard drive. Then open the file with a word program.)
All entries must be received with entry fee/donation or postmarked by the deadline for that "Theme".

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 of $25.00 U.S. 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____________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________



ENTRANT INFORMATION 

NAME:_______________________________________

ADDRESS:___________________________________

____________________________________________

____________________________________________

CITY__________________________________________

STATE_________________________________________

ZIP CODE______________________________________

____________________________________________

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: __________________________________________

• $20.00 adults (18 years old and older)
• $15.00 for Teens 11 to 17 years old
• $10.00 for Youth 7 to 10 years old
• $5.00 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.
2804 S.E. 14th Street
PORTLAND, OREGON 97202
USA

Make checks and Money Orders payable to:
Global Media & Communications, Inc.

If you have questions about the contest, click here to e-mail us at
info@usanationals.com
or call (503) 234 7003