INSTRUCTIONS

1.  Complete the form below.
2.  Click on the submit button.
3. Print the form and return it to:

Meridian Anthology of Contemporary Poetry

C/O:

Phyliss Geller
10736 Avenida Santa Ana
Boca Raton, FL 33498

Name
Address
Suite / Apt #
City
State
Zip
Author of poem

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I give permission for one time rights to publish my poem in
MeridianAnthology of Contemporary Poetry. 
By submitting this form I agree that if my poem is selected, I grant consent to Meridian Anthology to publish it in the anthology of its choosing.

Please type the word AGREE (UPPER case only) in the box below then press the
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