Entry Form

Thank you for contributing your story to this community effort! Before submitting please review the Contest Guidelines.

Once we receive your entry, we'll confirm receipt by phone or email. If you don't hear from us two weeks after submitting, please contact us at info@thewomensinitiative.org or call our office at (434) 872-0047.

One entry per person, please. Submission deadline is December 15, 2017.

Name *
Name
Phone *
Phone
Address *
Address
Address
Permission for Publication *
I give permission to have my writing published. I can choose to be anonymous or use only my first name. Checking yes means I also agree that my writing may be read on radio and appear in any media, including The Women's Initiative website.
Permission for Photograph *
I consent to having my photograph taken at the award ceremony. I understand photos may be used in announcements of the event or awards, or on The Women's Initiative website.
Agree to Terms and Conditions *
As an entrant to the 2017 Challenge into Change Writing Contest, I am fully aware of and understand the GUIDELINES and TERMS OF THIS AGREEMENT
Date *
Date