2007 ENTRY FORM
Anson County Writers' Club Adult Prose/Poetry Contest
Entry form must be submitted with each contest entry)

NAME _________________________________________________

ADDRESS _____________________________________________

TELEPHONE (Home) _______________(Business)______________

TITLE OF WORK __________________________________________

Number of words (Prose) _________Number of lines (Poetry)________

I certify that this is my own work.

SIGNED _________________________________________________
                                        (Author's Signature)

___ (Optional) Please check if you wish possible inclusion in future anthology.)

I hereby grant the Anson County Writers' Club permission to publish this work in a future Anson County anthology. I understand that all rights to the work will revert to the author following publication.

Entries are due by 5:30 p.m. on Friday, December 7, 2007.

COPIES OF THIS FORM ARE ACCEPTABLE