2011 Indiana Review Fiction Prize Entry Form

First Name:	Middle (optional):	Last:

How did you find out about the contest?
If 'Other Journal' or 'Other,' please elaborate:

Street address:
Address line 2:
City: State: ZIP:

E-mail address:

Phone number:

Submission title:

*Please do not include more than 1 story per entry fee.

Include a $15 entry fee (for the subscription, overseas addresses, please add $12 for postage; $7 for addresses in Canada). If payment is made by check, make it payable to Indiana University. If payment made online, please indicate this in the comments section below, including the date on which you made your payment. In accordance with Indiana University policy, we cannot accept money orders or accept checks drawn on foreign banks or in foreign funds.

Your entry fee entitles you to a one-year subscription to IR. In the comments section below, provide us with any additional information we might need to process your subscription. (For example, if the subscription should be given as a gift, then note this, along with who will the recipient will be.)

If you have any additional questions or comments for the editors of IR, please include them here.

When you have finished filling out the entry form, select 'File' and then 'Print'
and include a copy of the form with your submission and entry fee.