EmailMe Form - For Love of Country ©: In My Own Words 2022

Name *

First Last

Address *

Street Address City State Zip Code

Email Address *

Phone Number *

### - ### - ####

School Name

Grade (Fall of 2022) *

7th Grade

8th Grade

9th Grade

Age

My neighborhood library branch is: *

Beatley Central

Barrett Branch

Burke Branch

Duncan Branch

Student Agreement *

Yes

No

I have followed the rules and guidelines as outlined; my work is original work. If my writing is selected, I agree that the Alexandria Library and/or media outlets may use my work.

Parent/Guardian Agreement *

Yes

No

I have read the rules and guidelines and allow my child to submit an original essay/poem to the Alexandria Library. I understand that this work may be posted on the library’s website and social media, and/or used in other media outlets (using only the first name and last initial to identify).

Parent/Guardian Email Address *

Please provide a parent/guardian email. Once form is submitted a confirmation email will be sent to the parent.

Entry type *

Entry Title *

Upload contest entry *

Contest entry must be uploaded as a Word document (.doc or .docx) or PDF.