Online entry form: 2019 Young Poet Hippocrates Awards
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Title of your poem *
Your answer
First line of your poem *
Your answer
Category for your entry *
Family name *
Your answer
Date of Birth *
Required for Young Poet entrants
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Forenames *
Your answer
First line of address *
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2nd line of Address *
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Town/city *
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County/state *
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Country *
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Post code *
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Phone no. *
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email address *
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Text of poem *
Maximum of 50 lines in addition to line breaks
Your answer
I agree to be contacted about future Hippocrates Initiative activities *
I am interested in information on the Hippocrates Society for Poetry and Medicine *
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