Powerful Narrative Registration Form

Please print out the form, complete it, and “snail mail” to us (see address below).

Registration Form: the Powerful Narrative Writing Workshop
Wildacres Retreat Center
Little Switzerland, NC

SEPTEMBER 16 – 20, 2013

Register early to reserve your place in the program. A $200 deposit per person (nonrefundable) will secure your place in the workshop. Full payment of tuition is due no later than August 25, 2013. Tuition is totally non-refundable after this date.




HOME PHONE________________________

CELL PHONE_______________________


EMERGENCY CONTACT PERSON_____________________

CONTACT’S PHONE NUMBER:__________________________

ROOMMATE REQUEST (Name):_________________________________

DOUBLE ROOM ($575) ________
SINGLE ROOM ($675) _________

Consider bringing someone you like as a roommate. A roommate will be assigned if your preference is not indicated.

GUEST (non-participating) DOUBLE ROOM ($295) ________ *

TOTAL: _____________________

* Non-participating guest (all meals, no workshop, double room) $295

To secure your place, we require a $200 deposit per person (nonrefundable). Full payment of tuition is due no later than August 25, 2013. After this date, tuition will not be refunded for any reason.

A confirmation of your registration will be sent to you via e-mail. Your check guarantees your spot in the workshop.

Make checks payable to:

Send Registration material to:
Carol Henderson
804 Woodland Avenue
Chapel Hill, NC 27516

Questions? cd.henderson@gmail.com

We’ll be sending out more information over the coming weeks.
919-942-2127 (home)
919-619-4873 (cell)