APPLICATION FORM 2007 - 2008
BLOCK CAPITALS please. Note that co-authors must each complete and sign an application form

Author Reference Number ................................ EMAIL................................................

NAME: Title.............First name..................................Surname...................................

ADDRESS...........................................................................................................................................................

.............................................................................................................Country...........................................

TEL: NUMBER ...................................... OCCUPATION ..................................

ARE YOU A PUBLISHED AUTHOR?.........................WEBSITE?................................

HOW MANY ESSAYS ARE YOU SUBMITTING? ..............

TITLE OF ESSAY 1..............................................................................................................
No of words inc notes ..............
TITLE OF ESSAY 2...............................................................................................................
No of words inc notes ..............

ARE THE ESSAYS CO-AUTHORED? Please tick.............
Give the name of your co-author...............................................

I HAVE SUBMITTED MY ESSAY(S) AND ILLUSTRATIONS ELECTRONICALLY. Tick here...........
Please give date of electronic submission.....................
I WILL SUBMIT MY ESSAY AND ILLUSTRATIONS ON (give expected date)...................
I HAVE NO ACCOMPANYING ILLUSTRATIONS. Tick here.....................

I AM UNABLE TO SEND AN ELECTRONIC VERSION. Please tick here...............
I ENCLOSE ONE HARD COPY OF MY ESSAY(S) WITH THIS FORM Tick here.................
(Do not fax your essay)

* I DECLARE THAT I HAVE SUBMITTED MY OWN WORK. Tick here.............
* I CONFIRM THAT THE WORK SUBMITTED HAS NOT PREVIOUSLY BEEN PUBLISHED IN ANY FORM, INCLUDING THE INTERNET. Tick here..........
* I AGREE THAT MY ESSAY MAY BE EDITED FOR PUBLICATION IF SELECTED AS THE WINNING ENTRY. Tick here..........
* IF MY ESSAY IS SELECTED AS THE WINNING ENTRY, I AGREE THAT I WILL PROVIDE PERMISSIONS AND CLEARANCES FOR ALL ILLUSTRATIONS. Tick here............
* I HAVE READ AND ACCEPT THE RULES. Tick here............

SIGNED............................................... DATE...............................

Please post or fax this form to:

PB ESSAY AWARDS 12 High Street Hastings East Sussex TN34 3EY UK

Fax: +44 (0)1424 204144

admin@pbawards.co.uk

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