3rd Annual Poetry Slam Against Violence Registration Form
Hosted by Students for Violence Prevention
Registration Due: Tuesday April 5th by 4:30pm
Name: ______________________________________
Preferred Gender Pronouns (Circle One):
She/Her/Hers
He/Him/His They/Them/Theirs Ze/Zir/Zirs
Other: __________
Email: ___________________________
Phone: _______________________
School Classification (Circle One):
SO
FR
JR
SR
GR
Major: ____________________________________
Name of Poem: ____________________________________________________
Author of Poem: _________________________________________
Length of Poem Read Aloud: ___________________________ (Limit 3 minutes)
Description of Poem (to be read when introducing you at Poetry Slam):
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Because of the sensitivity of this topic –
please attach typed poem to this form
REGISTRATION FORM DUE TUESDAY APRIL 5TH
Please return form to: The Campus Activities Center, located in the Overman Student Center or email
to pittstatesvp@gmail.com or to advisor Ali Smith, alisonclark@gus.pittstate.edu. You will be
contacted with details of the Poetry Slam following your registration. Guest judges will be announced
closer to the event. Cash prizes will be given to 1st, 2nd, and 3rd place winners.