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