Powerful Narrative Registration Form

REGISTRATION FORM: THE POWERFUL NARRATIVE WRITING WORKSHOP
Wildacres Retreat Center
Little Switzerland, NC

OCTOBER 10 – 14, 2011
Register early to reserve your place in the program. A $195 deposit per person (nonrefundable) will secure your place in the workshop. Full payment of tuition is due no later than October 1, 2011. Tuition is non-refundable after this date.

NAME _______________________________________

ADDRESS ___________________________________

____________________________________________

HOME PHONE _________________________________

CELL PHONE __________________________________

EMAIL _______________________________________

EMERGENCY CONTACT _______________________

CONTACT’S PHONE NUMBER ___________________

ROOMMATE REQUEST (Name): _________________

SINGLE ROOM ($625) _________
DOUBLE ROOM ($525) ________
GUEST, DOUBLE ROOM ($295) ________

TOTAL: _____________________

Your check guarantees your spot in the workshop. A confirmation of your registration will be sent to you via e-mail. Questions? cd.henderson@gmail.com We will be sending out more information over the next weeks.

Make your check payable to:
Carol Henderson Writing Workshops, L.L.C.

Mail check to:
804 Woodland Avenue
Chapel Hill, NC 27516

(919) 942-2127
(919) 619-4873 (cell)