E Short Story and Poetry Contest 2006 Entry Form Please Print. Use black or blue ink. Thank you.

Name: ________________________________.

Date of Birth (dd/mm/yyyy)__________ .

Address: _________________________

_____________________________________.

Town/City: __________________________.

County:_______________________________.

Country: ____________________________.

Postal Code: _____________________.

Phone: Day: __________________________.

Evening: _____________________________.

Mobile: ______________________________.

Email: _______________________________________.

Website:______________________________ .

Entry Title: _______________________________________.

Entry Type: Place a check on line.

_____Short Story. ___Poem.

I am the sole and original author of the piece submitted. It is unpublished and has not won any competitions. I agree to participate in any publicity attached to the competition and have my works published on the sponsors' web sites. I accept the judges' decisions are final.

Remember: Do not put your name on the submission, only on this form.

Signature:______________________________.

Date: ______________.

Entries should be posted with the completed entry form to: The Web Editor, The Westmorland Gazette 1 Wainwright's Yard, Kendal, Cumbria LA9 4DP or 25 Market Street, Ulverston, Cumbria LA12 7LR brought to you by The Westmorland Gazette website www.thisisthelakedistrict.co.uk and Word Market online at www.word-market.co.uk.