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To fill out application, copy and paste into a Word document:

Binghamton Center for Writers

State University of New York

 

BINGHAMTON UNIVERSITY MILT KESSLER POETRY BOOK AWARD 2013 Application Form

 

 

Name of Author ________________________________________________

 

Home Address _________________________________________________

(listing as c/o publisher may result in a delay; to receive early verification, list your own address)

 

Phone Number _(______)______-_________ E-mail ___________________

 

Social Security Number ________ - _______ - __________

(may wait for results to supply if you prefer)

 

Title of Book ___________________________________________________

 

_______________________________________Cost of Book__________

 

 

Publisher_________________________________________________

 

Contact's Name at Publisher ____________________________________

 

Publisher's Address _______________________________________________

 

__________________________________________________________________

 

Phone Number _(______)______-_________ E-mail ___________________

 

Date of Application _____________________________________________

 

 

 

I understand that books cannot be returned.

DEADLINE MARCH 1, 2014

 

Send three (3) copies of each book with application to:

Maria Mazziotti Gillan, Director

Binghamton Center for Writers - State University of New York

Department of English, General Literature, and Rhetoric

P.O. Box 6000

Binghamton, NY 13902-6000

 

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Last Updated: 3/15/13