Submission Form Poetry Competition
“Utrecht: Your Place, Your Words”

First Name: *

Infix:

Last Name: *

Email address: *

Phone number: *

Required so that we can contact participants quickly.

Age: *

The jury will assess submissions in two categories: 18 years and younger, and over 18 years.

Location the poem is about:
The location must include at least a street name and city. If known, please also add a house number and postal code.

Address: *

Attachments

Attachment 1:

If you have an audio or video file, we kindly ask you to upload it yourself and enter the URL of the file below.

URL:

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