Amaravati Poetic Prism – 2021 AMARAVATI POETICPRISM Step 1 of 4 25% AMARAVATI POETICPRISM–2021 POETS’ REGISTRATION FORM PLEACH India Foundation works towards entwining rich Indian heritage with present-day life, reconnecting us with our cultural identity. CCVA, the unit of PLEACH proudly presents Amaravati Poetic Prism 2021, the seventh edition of the International Multilingual Virtual Poets’ Meet. Important Guidelines: Each poet can submit only one poem in their language of choice. Poet shall declare and confirm that the poem submitted in this form to The Cultural Centre of Vijayawada & Amaravati(CCVA) is written by him/her only and is not published anywhere else/not proprietary material of others. CCVA shall not take any responsibility in regard to the copyright of the poem and it is the complete responsibility of the Poet only. The top 100 Poems in all languages combined will be selected by the eminent panel of CCVA. CCVA reserves the right to selection of the poems. The selected poems shall be rendered by the poet during the Virtual Meet in the month of February 2022. Dates and final schedule will be rolled out separately. CCVA reserves the right to make/alter any changes in the deadlines, schedule, dates, postpone or cancel the event, etc., All the information provided in the form shall be strictly confidential. Registration Deadline : 20th December 2021. Consent* I hereby agree to all the above guidelines and submit the Poem. PERSONAL DETAILS Please fill in all the relevant details as per the guidelines specified. NAME:* First Name Last Name PHONE NUMBER:*EMAIL ADDRESS:* DOB:* DD slash MM slash YYYY GENDER:* Male Female ADDRESS:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country LANGUAGES SPOKEN: PROFESSIONAL DETAILS Section Guidelines: Please fill in all the relevant details as per the guidelines specified. Poet’s Personal Brief: 7lines of your brief, third-person bio in English focusing on your literary journey, awards and other recognitions, books published etc. Profile Pic: Please upload your high-resolution picture in JPEG format with a size not exceeding 2MB. EDUCATIONAL QUALIFICATIONS:* PROFESSION:* PERSONAL BRIEF:*Accepted file types: doc, pdf, Max. file size: 10 MB.PDF of MAX. SIZE: 10 MBUPLOAD PROFILE PIC:*Max. file size: 2 MB.MAX. SIZE: 2 MBPOETRY WRITTEN IN LANGUAGES:*PUBLICATION DETAILS OF YOUR POETRY IN CHRONOLOGICAL ORDER:*AWARDS AND RECOGNITIONS: POETRY SUBMISSION Section Guidelines Please fill in all the relevant details as per the guidelines specified. Poem shall be strictly related to the Theme mentioned above and should not exceed more than 20 lines. English Translation of all the poems in other languages is compulsory and have to uploaded in the relevant column below. All the poems and the translations will be uploaded in *PDF format only. Each file size shall not exceed 10MB. TITLE OF THE POEM:* LANGUAGE OF THE POEM:* LINE COUNT OF THE POEM:* ABOUT THE POEM:*NAME AND ADDRESS OF THE ENGLISH TRANSLATOR (FOR OTHER LANGUAGE POEMS):SUBMIT YOUR POEM HERE:*Accepted file types: pdf, Max. file size: 10 MB.PDF of MAX. SIZE: 10 MBSUBMIT THE ENGLISH TRANSLATION OF THE POEM HERE (FOR OTHER LANGUAGE POEMS):Accepted file types: pdf, Max. file size: 10 MB.PDF of MAX. SIZE: 10 MBSELF DECLARATION:* I do hereby declare that the poem submitted to APP 2021 Virtual Poets' Meet of CCVA is written by me and not copyrighted or published anywhere else. I am solely responsible for any claim in regard to copyright and publication of the Poem submitted. Further, agree that CCVA does not have any responsibility for any such claims in future.