Braille House Home page
BRAILLE HOUSE
Dickinson Memorial Literary Competition 2020
ENTRY FORM
(A separate entry form must be submitted for each entry).
THEME: Movement CLOSING DATE: Monday, 31st August 2020
6 Categories of Entry:
1. Adult Short Story
2. Adult Poem/Song Lyrics/Limerick
3. Adult Article/Opinion eg: self-reflection, blog
4. Senior Student Creative Category, eg: story, poem, song lyrics, limerick, blog
5. Junior Student Creative Category, eg: story, poem, song lyrics, limerick, blog
6. Peoples Choice Category – Short Story. All entries will be published for the public to vote on.
Category of entry: …………………………………………………………………………………………………….
Name: (please print) ……………………………….. ……………………………….. ……………………………
Address: ……………………………….. ……………………………….. …………………………….. ……………..
Suburb/Town: ……………………………….. ……………………… State: ……………. Postcode: ………..
Mobile phone: …………………………………….. Landline phone: ……………………..…………………….
Email: ……………………………….. ……………………………….. …………………………….. ………………….
Title of Entry: ……………………………….. ……………………………….. …………………………….. ………
Number of words: …………………………….
Method of payment: ……………………………….……………… Entry Fee Payed:……………….
Cheques and money orders are to be made payable to QBWA (or Queensland Braille Writing Association). Credit card payments can be made by contacting Braille House by telephone on
07 3848 5257. For direct deposit please use BSB: 034-033, Account: 20-2253.
DECLARATION:
I certify that the work entered in this Literary Competition is my own, is unpublished, will not be offered for publication before the announcement of the awards, and has not won a cash prize in any previous competition. I further certify that I am a resident of Australia who is legally blind, or has low or no vision (unless entering Category 6). By entering this competition I agree to my work being published by Braille House in the In Touch Braille Magazine and in a Winner’s publication should Braille House choose to publish one. I understand that copyright will at all times remain with me, the author.
I have read the conditions of entry into this Literary Competition and agree to abide by them.
Signed: ……………………………………………………. Date: ………………………………….
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FOR OFFICE USE ONLY
Date received: ………………. Entry fee received by Chq / DD / CC on: …………………. Receipt no:………………………
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