<p> Return form to: Cicely Bosley WV Division of Culture and History The Culture Center, State Capitol Complex 1900 Kanawha Blvd., East Charleston, WV 25305-0300 Phone: 304-558-0240 - Fax: 304-558-3560</p><p>Finalist Registration deadline for submission: January 30, 2013 Complete and return this form immediately following your school competition</p><p>School: </p><p>Teacher: </p><p>School Champion Name: </p><p>School Champion Parent/Guardian Name: </p><p>Home Mailing Address (city, state, zip): </p><p>Champion Phone: </p><p>Champion Email: *Important and time sensitive contest information will be shared via email POEM SELECTION Please read carefully  The order in which poems are submitted is the order in which they will be performed – no changes.  Poems must be selected from the Poetry Out Loud anthology, either the online or print edition - no exceptions. Make sure poems are selected from the most recently updated anthology.  At least one poem must be 25 lines or less; at least one poem must be pre-20th century. One poem can satisfy both requirements.  Refer to www.poetryoutloud.org for rules, eligible poems, and tips on poem selection and performance.</p><p>Title Author 1. Pre 20th Century? 25 lines or less? </p><p>2. Pre 20th Century? 25 lines or less? </p><p>3. Pre 20th Century? 25 lines or less? </p><p>Updated 08/21/12 CJB Return form to: Cicely Bosley WV Division of Culture and History The Culture Center, State Capitol Complex 1900 Kanawha Blvd., East Charleston, WV 25305-0300 Phone: 304-558-0240 - Fax: 304-558-3560</p><p>Runner-Up Registration deadline for submission: January 30, 2013 Complete and return this form immediately following your school competition</p><p>You may submit one student name as a runner-up. In the event your finalist cannot participate in the State Finals, the runner-up may compete. In the event that your runner-up cannot attend, your school will forfeit the competition. Runner-up Name: </p><p>Runner-up Name: </p><p>Runner-up Parent/Guardian Name: </p><p>Home Mailing Address (city, state, zip): </p><p>Runner-up Phone: </p><p>Runner-up Email: *Important and time sensitive contest information will be shared via email</p><p>POEM SELECTION Please read carefully  The order in which poems are submitted is the order in which they will be performed – no changes.  Poems must be selected from the Poetry Out Loud anthology, either the online or print edition - no exceptions. Make sure poems are selected from the most recently updated anthology.  At least one poem must be 25 lines or less; at least one poem must be pre-20th century. One poem can satisfy both requirements.  Refer to www.poetryoutloud.org for rules, eligible poems, and tips on poem selection and performance.</p><p>Title Author 1. Pre 20th Century? 25 lines or less? </p><p>2. Pre 20th Century? 25 lines or less? </p><p>3. Pre 20th Century? 25 lines or less? </p><p>Updated 08/21/12 CJB</p>