Name *

First Name

Last Name

Phone

(###)

###

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What services are you interested in? *

Performance at your event (Greater Toronto Area)- 2 existing poems ($500) Non- Profit/Churches/Schools ($300)

Customized written poem to your event's theme + 1 existing poem + performance (Greater Toronto Area) ($700) Non-Profit/Churches/Schools ($500)

Address of the event

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country