The Ontario Poetry Society

Delicate Impact
Bio Information Form - Please Print Neatly

Name: _________________________________________________________________________

Pen Name: (if different from real name) _______________________________________________

Postal mailing address ________________________________________________________

__________________________________________________

Phone Number &/or e-mail _______________________________________________________

Kindly answer up to all three of the following questions, each answer per question to be no more than two sentences.

Add a separate sheet with your bio answers and add your name on the top left corner of the page.

1. If you could change one thing in your life past or present, what would it be and why?
2. If you could be EITHER a world leader, a brilliant scientist, or a multi-millionaire, which one would you choose to be and what would be your first act?
3. Which major Hollywood movie star would you select to portray you in a movie about your life and what would the film be called?

Poem Titles and Themes Submitted for Delicate Impact

Poem Title: Theme:

__________________________________ __________________________________

~ THIS PAGE MUST BE COMPLETED AND INCLUDED WITH YOUR SUBMISSION ~
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