Entry Number (leave blank) ___________________

HASSAYAMPA WRITERS’ CLUB 2010-2011 CONTEST SUBMISSION

TITLE OF WORK: ____________________________________________

Word Count / Line Count: _________/__________

Author’s Name _____________________________________________

Address: __________________________________________________

Day Phone: ______________ Evening Phone: __________________

E-mail address: ___________________________________________

Category entered (check one):

 Poetry      Fiction      Non-Fiction

A $15 entry fee is required for each item submitted. Please use physical mail (U. S. Postal Service) for your payment. You may send one check for several entries. For example, if you have three entries, you may send one check for $45.00.

Please make checks payable to Hassayampa Writers’ Club.

Number of entries: ______________

By submitting an entry to this contest, you give your assent to the publication of your entry in The Hidden River Cache. If your entry is selected for publication, you will be asked to send the editor an electronic copy (e.g., Microsoft DOC format).

Please sign and date the following:

I grant permission to Hassayampa Writers’ Club to publish my entry (or entries) in the contest issue of the Hidden River Cache, if applicable.

Signature________________________________ date _

Mail completed form & check to Writers’ Contest, Hassayampa Writers’ Club, PO Box 388, Wickenburg AZ 85390.

For questions, call 928-684-4910 or e-mail to secretary@hassayampawriters.org___________

This form is also available as an Adobe Acrobat portable document (PDF) file. Click the link here: Contest Cover Sheet PDF.