Application Form

Application Form

Please print this out on your own paper, or write clearly the following informations:

1. Name:

2. DOC # :

3. Exact address:

4. Birthdate:

5. Interests :

6. Short statement about yourself:

You are very welcome to send in any artwork, poems or short stories you'd like to publish on our site !

Prisoners Light House
PO BOX 10
6980 Castelrotto
Switzerland

Please include the following signed statement:

I ______________________________________________
give my permission for Prisoners' Light House to list my name and address and personal information on their website.They may publish my artworks, poems or short stories I submit for use by Prisoners Light House.

Do NOT break our rules such as use of offensive material or solicitation of any kind !