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Christian Poet Laureate Application Form

You may fill in this form from your keyboard and print it. Or you may print the blank form and fill it in by hand. The completed form (either way) must accompany your application materials.

Poet's Name:

Address:

City:

State/Province:

Country: Postal Code:

Telephone:

Email Address:

If appointed Poet Laureate, do you agree to allow your name and photograph to be published and promoted as Poet Laureate? Do you also agree that we may also name the town or city of your residence? (Your exact address and other personal information will be kept private.)

          Yes, I agree.
          No, I cannot do this.

Please date this form and sign your name by hand to affirm that you are in agreement with the conditions of appointment as Utmost International Christian Poet Laureate.

Date: ______________________________


Please sign your name in box above to affirm.