2Impress

2Impress  WRITING COMPETITION 

Full name ……………………………………………………………………….…………..

 Address………………………………………………………………………………….……

            ………………………………………………………………………………………...

             ……………………………………………………….. Post code……………….

Telephone ………………………………………………..  This is for emergencies only. Contact will be by email.

Email ……………………………………………………...................................................…..          

This is essential information. If you do not have an email please give one where you can be contacted.

Chosen Pseudonym ………………………………………………………………………..

Title of piece submitted 1………………………………………………………………………

 Category……..………………………..

Title of piece submitted 2………………………………………………………………………. 

Category..……………………………..

Payment made by …………………………………………….. on date……………………………..