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National Poetry Day 2013

Information Form

If you would like to commission a poem, you could use this information form.  This information will be used to enable me to write the poem and will not be used for any other purpose, or shared with anyone else.  Using the form is optional and you may prefer to e-mail the information instead.

If you are looking for a report to be turned into accessible verse, please e-mail helen@sublimerhyme.co.uk instead of using this form.

Your Name
Your E-mail Address
Full Name of Recipient
Occasion / Event
Age of recipient (if known, if relevant)
Area where recipient lives (if relevant)
Your Relationship to the Recipient (e.g. mother, friend, neighbour, enemy etc.)
Is there a particular phrase or similar you would like to be included?

Details (Please mention any other information which you would like to be incorporated into the poem)

When do you require the poem by?
Would you like the poem to be written in a particular style? If so, please give details.
Thank you.