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Fool for Love Contest

Entry Form

Electronic entries must be sent via e-mail by April 30, 2010, midnight EST.

Name
Street
City, State
Zip Code
Phone
Alternate Phone
E-mail
VRW Member?

Pseudonym (if any)
Partner (if any)

Title of Entry
Category (choose one)





Targeted Line/Publisher

Entry Fee



  Note: By choosing Paypal, you have an option to pay via credit card if you do not have a Paypal account.
Name/E-mail used on Paypal account (if applicable)

Check # (if applicable)

Contestant Waiver

Image Verification
captcha
Please enter the text from the image:
[ Refresh Image ] [ What's This? ]
Form processed by
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Once you click on the SUBMIT button, you will be taken to the payment option page with further instructions. You will also receive a confirmation e-mail from burst@emailmeform.com of the information you have submitted.

If you enter the wrong image verification code, you will be brought back to the form page.
PLEASE MAKE SURE ALL BOXES ARE CHECKED,
including the Category Selection and Contestant Waiver boxes,
before resubmitting the form (some may have cleared themselves).

Email questions to: foolforlove2010@verizon.net

 

Updated Mar. 4, 2010


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