Haunted Hearts Contest Entry Form

Full Name(s):
Street Address:
City:
State:
Country:
Zip or Postal Code:
Pseudonym:
Phone Number:
RWA Member Number(s)
E-Mail Address:
Manuscript Title:
Manuscript Target Line (optional):
Manuscript Word Count:
Manuscript Category:	Historical   Contemporary

My entry is:

  Gothrom Member ($15.00)
  Not a Gothrom Member ($25.00)

CONTEST WAIVER (must be checked below for entry acceptance)

I have read and understand the above rules and request that the enclosed original work, which I declare to be my work, be entered in GOTHROM’s “Haunted Hearts” contest. By signing this entry form I accept that manuscript judging is subjective and agree to abide by the decisions of the judges and/or contest officials and shall indemnify and hold harmless GOTHROM, its officers, members and contest personnel for actions relating to the judging and handling of my entry

I agree: Yes

You only need to hit the Send button one time Thanks!