| NAME |
| ADDRESS |
| CHECK BOX FOR VERIFICATION OF YOUR ORIGINAL WORK |
| CHECK BOX FOR AUTHORAZATION OF USE |
| TITLE |
| POETRY |
| You have reached the submissions page, Please feel free to leave a poem. All poetry leftt must be your original work. However poetry left here could be published in an up and comming book of poetry. If your poetry is selected you will be notified by email so please fill in all requested areas. PLEASE NOTE: This is not a gaurentee that your work will be published. |
| URL IF ANY |
| THANKS FOR ALL YOUR TIME |
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