Workshop Registration Form                          

PLEASE PRINT CLEARLY

 

Name _____________________________________________________________________________________

 

Address ___________________________________________________________________________________

 

Phone number _______________________  Email _______________________________________________  

                                                                                             (A reminder will be sent if email is provided.)

Are you a member of MWC?   ___________

 

Name of workshop(s) ______________________________________________________________________

                                      

Date(s) of workshop(s) _____________________________________________________________________

 

Cost of workshop(s) ___________________________

 

Total amount enclosed _________________________

 

Checks should be made payable to Midwest Writing Center

 

Please charge to my Visa or MasterCard

 

Expires _______________Card Number _____________________________________ V-code __________

 

Signature _________________________________________________________________________________

 

 

Please understand that any refunds will be in the form of workshop credits and will be issued only upon request. 
 There will be no refunds issued if requested less than 3 days prior to the workshop.