- Gilda's Club Kentuckiana

Write Stuff Contest

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Personal Information

First Name *

Last Name *

Suffix

Preferred Name

Home Address *

City *

State *

Zip *

Household Address

New Address

Email *

Home Phone

Work Phone

Cell Phone*

I agree to receive text messages at this number.

Date of Birth *

Gender

Record Type

Status

Organizations:

Please fill out the following information for the Write Stuff contest. All fields must be completed in order for your submission to be considered. Both the student and parent/guardian are required to consent by typing your names into the fields below.

Child Consent:
By typing my name and today's date below I agree that I have read the contest rules and agree that my submission is my own original work. I understand that my entry must reflect my own experiences, words and reflections (other than cited quotes and material). I understand that my entry may be displayed, in whole or in part, in print publications and on www.gck.org.

Parent Consent:
By submitting my electronic signature below, I give consent for my child’s participation in Gilda’s Club Kentuckiana’s Write Stuff Contest. I understand the goal of this program is to offer the chance to express oneself creatively while on a cancer journey. I understand that my child’s entry may be displayed, in whole or in part, in print publications and on www.gck.org.

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2440 Grinstead Dr, Louisville, KY 40204, 502.583.0075

1720 W Broadway, Ste 205, Louisville, KY 40203, 502.371.3040

1218 E Oak St, New Albany, IN 47150, 502.371.3050
5318 King Rd, Jeffersonville, IN 47130, 502.371.3050

Write Stuff Contest

Step 1: Please fill out all of the information below

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