West Virginia Department of Commerce Submit a journal entry

We want to hear from kids (age 17 and under) about your favorite
West Virginia places or fun experiences you would like to share with other kids. If you are ready to get in on the fun, then tell us about it!

By submitting a journal entry, you are telling us:

• Your parent has given you permission to submit an entry.
• My parents and I agree the West Virginia Department of Commerce has the right to use my journal entry on the kid’s page website.
• My parents and I agree the West Virginia Department of Commerce and those acting with its authority have permission to re-use and reproduce this journal article for promotion of the state of West Virginia either in advertising or on the web.

1. First Name (Required)
2. Last Name (Required)For internal use only. Last name will not be published.
3. City, State, Zip (Required)
4. Preferred Phone (Required)Please enter a phone number in this format: 555-555-5555.
5. Alternate PhonePlease enter a phone number in this format: 555-555-5555.
6. Parent's Name (Required)
7. Parent's email: (Required)A parent's email address is required.
8. Your Age (Required)
9. Date (Required)

   Open the calendar popup. << < June 2013 > >>   S M T W T F S 22 26 27 28 29 30 31 1 23 2 3 4 5 6 7 8 24 9 10 11 12 13 14 15 25 16 17 18 19 20 21 22 26 23 24 25 26 27 28 29 27 30 1 2 3 4 5 6

   Please enter today's date.
10. Parental consentTo submit a journal entry, parental consent is required. By checking this box and giving us your parent’s name and email, you assert that a parent is aware of your journal submission and has given you permission to do so.
11. Journal Entry (Required)