MIDWEST WRITING CENTER WORKSHOP REGISTRATION FORM
PLEASE PRINT CLEARLY THE FOLLOWING INFORMATION
Date(s) of Workshop (s) ____________________________________
Your name _________________________________
Address ________________________________________
Phone number _______________________
Email ______________________________ A reminder will be sent if email is provided.
Are you a member of MWC? ___________
Cost of Workshop(s) ___________________________
Total amount enclosed _________________________Checks made payable to Midwest Writing Center
Please charge to my visa or mastercard (circle appropriate card)
Expiration Date _______________
Card Number ___________________________
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.