'APPLICATION' FORM

Please fill out this form and send it to me at Blackandwhitestripes@hotmail.co.uk =)

NAME:

POETRY NAME (The name you'd like to feature on the site):

EMAIL ADDRESS:

NUMBER OF POEMS:

COLOUR YOU'D LIKE YOUR POEMS TO BE DISPLAYED IN (All backgrounds will be Black) :

PICTURE (The picture you'd like on your contents page):

MESSAGE (The message you'd like to put on your contents page):

Copy and paste this into word or notebook and fill in the spaces then copy and paste it into an email. :)