Poet's Name:
First
Middle
Last
E-mail Address:
E-mail
Complete Address:
Address
 
City
 
State/Prov.
 
ZIP/Post Code
 
Country
 

Poem Title:
Your poem (21 lines or less):
 

Note: If your poem does not fit in this box, it exceeds 21 lines and does not qualify One original poem only!



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Free Poetry Contest
PO Box 21
Talent, Oregon 97540


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