Space for Ourselves Registration Form

Space for Ourselves

A Writing Group for People Living with Illness

  • When: 8 Tuesdays: February 3-March 24, 7-8:30 pm
  • Where: United Church of Chapel Hill, Room 229
    1321 Martin Luther King, Jr. Blvd
    Chapel Hill, NC 27514
  • The group will culminate in a reading at Flyleaf Books

Registration Form

Please complete this registration form (below) and return it by mail or bring to the first session. You may pay either by PayPal or check. (If you do not have a PayPal account, PayPal offers a credit card option).

PayPal: click below





Check: Make payable to “Carol Henderson Writing Workshops, LLC” and mail to: 804 Woodland Ave. Chapel Hill NC 27516. (Include “Space for Ourselves” on memo line.)

Cost is $200. Some scholarship funds are available based on need. For questions or more information, call 919-619-4873 or email fartheralongwriting@gmail.com

NAME:_______________________________________________________

ADDRESS:____________________________________________________

HOME PHONE:_________________________________

CELL PHONE:__________________________________

EMAIL:______________________________________________________

EMERGENCY CONTACT PERSON:______________________________________

EMERGENCY CONTACT’S PHONE NUMBER:________________________________

DO YOU NEED ANY SPECIAL ACCOMMODATIONS?_____________________________