Public Safety Writers Association
Writing Competition Entry Form

You can fill out this form on your computer and then print it, or print a blank copy and complete it by hand. 

Entrant Information Entry No. (leave blank) __________
Name

Address
City/State/Zip
Phone E-Mail Address
Date submitted 
Entry Information
Category:   Fiction          Non-Fiction          Poetry    

        Technical Writing       Training Materials    
Type:         Book      Flash         Short Story          Article    

                   News Article          Regular or Ongoing Column

Has this work been published?   Yes      No
If published, when, where, and by whom?
Do you have any comments you would like to add about this work?
If I win an award, I would like a press release sent to the following publication(s):

I affirm that this is my original, unedited work.*

I enclose a check or money order for $10, made payable to the Public Safety Writers Association. 
 

Signature: _____________________________

Date submitted:
Please submit this form (each entry must have a separate entry form, although several entries may be submitted in the same envelope or package) to:

Public Safety Writers Writing Competition
535 W. Oregon Ave
Creswell, OR 97426
 

*In the case of work published in a newspaper or magazine, we realize that your work may have been edited to some extent, but the work must bear your byline and be substantially your unedited work.