ENTRY FORM:

Name______________________________________________________
Address_____________________________________________________
State/prov________ ZIP/PC _______________  
Phone(      )_____________
e-mail_______________________________________________________
I  ____________________  am entering (title(s))_____________________

@ $6.13 per entry for the Halloween writing contest sponsored by Rusty
Bumper. I acknowledge that the piece(s) submitted are my original and
previously unpublished work. I agree to the terms and conditions as stated
for this contest.

Signature_________________________________

Date:____________________________________
Rusty Bumper
Halloween
Writing Contest
2009
Rusty Bumper punk infant clothes black brown cute
Halloween Writing Contest
c/o Rusty Bumper P.O. Box 8171
Holland MI 49422
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