Name: _____________________________

Address: _____________________

City: ________________   Zip Code: _____ 

Telephone: (     )___________

Email Address: _______________________

Check One:

 __Freshman    __Sophomore    __Junior                                                    
 __Senior   __Graduate Student

School: _________________________

Instructor: ___________________________

Class: __________________________

Name of Paper: _______________________

Applicant Statement:

I submit the attached paper to the Genesee County

Historical Society and, in doing so, grant them

all rights for publication purposes at no expense

to myself.  I further agree to attend the Society's

Annual Meeting to receive my award should

I win.  I agree to present my essay to the members

of the Historical Society at a mutually agreed

upon time.

 

Signature of applicant:

                                ___________________________                                   

                 

Date:

______________

Essay Contest Due Date: April 20, 2009

This form and paper should

be submitted to the:

Genesee County Historical Society,

316 Water Street, Flint, MI 48503