Entry Form

All India Poetry Competition Among School Children,2004

(The Poetry Society, India. L67A Malviya Nagar, New Delhi. Ph-91-11-24619325)

Name (In Block letter) ---------------------------------------------------------------------

Name and Address of School ---------------------------------------------------------------------

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Residential Address: ---------------------------------------------------------------------

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Tel. No: ---------------------------------------------------------------------

Sex: Male/Female Nationality: Indian/NRI/Others

(Tick which ever is applicable)

Date of Birth: ---------------------- Class: ------------------------

Contact Number: ---------------------- Email: ------------------------

Mother Tongue ----------------------

I wish to enter the following poem (s) for the All India Poetry Competition Among School Children, 2004

Titles (in block letters)

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(If you require more space, write or type the titles of the poems on a separate sheet of paper and attach

it to this form)

Declaration

I have read and completed the checklist overleaf. I have paid Rs. ------------------------ to my school towards the Entry fee. I have read and I accept all the conditions of entry.

Rs. ------------ No of titles --------.

DD No/PO No. -----------------------------------------------

Name and Bank -----------------------------------------------

Date -----------------------------------------------

Name ---------------------------------------------- Sign ------------------------

Date ------------------------

For office use

Results:

Winning poems will be displayed in both the sites: http://www.indianpoetry.org/ and http://www.indianpoems.com/.

(For Office Use Only)

Registration Id: -------------------------------- Amount Received.------------- No Titles. ---------

Date of Receipt --------------------------------

Before sending the entries, please read and complete the checklist overleaf.

CHECKLIST

Please read carefully and put a tick in the appropriate boxes below.

Poems entered for the competition.

Payment for ------paperback/copies of All India Poetry

Competition Among School Children.

1998 Anthology at Rs. 100/- per copy.

1996 Anthology at Rs.100/-per copy.

(Rates include postage and packing)

Payment for ------paperback copies of All India Poetry

Competition Among School Children.

2000 Anthology at Rs. 140/- per copy.

2001 Anthology at Rs.140/-per copy.

(Rates include postage and packing)

Payment for ------paperback copies of All India Poetry

Competition Among School Children 2003 Anthology at

Rs. 140/- per copy.

(Rates include postage and packing)

All entries, along with the entry forms, should be forwarded by the school and sent to:

All-India Poetry Competition Among School Children 2004

The Poetry Society (India)

L-67A, Malviya Nagar

New Delhi –110017, India

On or before December 31, 2004