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* 1. Name of presenter:

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* 2. Title of presenter:

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* 3. Cell phone number with area code:

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* 4. Email address:

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* 5. Mailing address:

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* 6. Do you Venmo?  
No - It's okay to say no!
Yes - How do we locate you there for payment?

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* 7. Format: 60 minutes via Zoom.  Confirm by typing yes below.  

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* 8. *Preferred April 2022 Date and Time Requested. 
(TIP: JaxPoetryFest 2021 lunctime sessions were very successful. We had poeple from all over the world attend our Zoom poetry sessions!) 
Write--
*1st Choice - day and time
*2nd Choice - date and time

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* 9. Workshop title:

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* 10. What form of poetry will you be teaching during this workshop?

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* 11. 50-word description of workshop:

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* 12. 50-word biographical statement for presenter:

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* 13. Email current head-shot to Jamie@HopeAtHand.org 
No sunglasses or ballcaps, please! Professional or playful head-shots welcome.

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* 14. I grant Jax Poetry Fest the perpetual, nonexclusive, royalty-free right and license to: • Record, reproduce or distribute my participation and appearance on digital/film photography, video, audio and/or other mediums • Use my name, likeness, voice and biographical material and information in connection with all Jax Poetry Fest written, electronic, web publications and social media. •I am voluntarily making this grant of rights. I further agree to release and forever discharge Jax Poetry Fest, its agents, employees and designated representatives from any and all claims in law or equity that I, my heirs or personal representatives have or shall have arising as a result of  my participation in Jax Poetry Fest. Auto-sign below

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