Bio form (temp)

Poet & Poem Information

Name *
Email *
Include Email address on bio page
Yes
Website
Include Website on bio page
Yes
Facebook
Include Facebook on bio page
Yes
Twitter handle
Include Twitter feed on bio page
Yes
Instagram
Include Instagram link on bio page
Yes
You Tube
Include You Tube link on bio page
Yes
Other Social Media Links
Postal Address
Phone
Bio *
Birthday We use your birthday as an opportunity to highlight your work on social media.
Poet's Pick
List a poem and/or Q&A you would like to be highlighted on your bio page.
Upload an author photo (or book cover) to appear on your Poets page
Poems will appear on the site in the order they are listed on this form. If submitting more than five poems, please continue your poem list on a second form.

Poem 1

Title
Attribution (publisher and/or issue & vol #, relevant web link)
Poem Category by topic
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Poem Category by poetic trait
List other categories that apply from above selection
Formal Structure
List other categories that apply from above selection
Appropriate Age
Country of Origin
Do you own copyright to this poem?
YesNo
Upload Poem Text in MSWord or RTF/Text file format

Poem 2

Title
Attribution (publisher and/or issue & vol #, relevant web link)
Poem Category by topic
List other categories that apply from above selection
Poem Category by poetic trait
List other categories that apply from above selection
Formal Structure
List other categories that apply from above selection
Appropriate Age
Country of Origin
Do you own copyright to this poem?
YesNo
Upload Poem Text in MSWord or RTF/Text file format

Poem 3

Title
Attribution (publisher and/or issue & vol #, relevant web link)
Poem Category by topic (choose all that apply).
List other categories that apply from above selection
Poem Category by poetic trait
List other categories that apply from above selection
Formal Structure
List other categories that apply from above selection
Appropriate Age
Country of Origin
Do you own copyright to this poem?
YesNo
Upload Poem Text in MSWord or RTF/Txt file format

Poem 4

Title
Attribution (publisher and/or issue & vol #, relevant web link)
Poem Category by topic (choose all that apply).
List other categories that apply from above selection
Poem Category by poetic trait
List other categories that apply from above selection
Formal Structure
List other categories that apply from above selection
Appropriate Age
Country of Origin
Do you own copyright to this poem?
YesNo
Upload Poem Text in MSWord or RTF/Txt file format

Poem 5

Title
Attribution (publisher and/or issue & vol #, relevant web link)
Poem Category by topic (choose all that apply).
List other categories that apply from above selection
Poem Category by poetic trait
List other categories that apply from above selection
Formal Structure
List other categories that apply from above selection
Age Appropriate
Country of origin
Do you own copyright to this poem?
YesNo
Upload Poem Text in MSWord or RTF/Text file format

Electronic Signature

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