Found at: http://www.yclusa.org/article/articleprint/1829/-1/5/

Dynamic Workshop Registration Form
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Author: YCL

Publishing date: 03.04.2008 13:23

Registration for Dynamic Writers Workshop April 26th, 27th


Deadline for registration is Friday, April 18th. Registration fee is $15.
If you cannot afford the fee please specify so in the special needs box.

Full name*:
Address*:
City*: State: ZIP*:
District: Best to reach me by:
Primary Phone*:
Secondary Phone:
E-mail*:

* Yes I need assistance with travel arrangements and/or costs.
*No I don’t need assistance with travel arrangements and/or costs

* If you are arranging your own travel, please note your itinerary below:

Arrival Date* Arrival Time Arrival Place
Depart Date* Depart Time Depart Place

* Yes, I need housing, please make arrangements for me.
* No thanks, I already have housing arrangements (see below).

Housing arrangements already made? If so, where?

Special needs: (like dietary, health, housing preferences, low funds)

to send to Dynamic

*required fields



Receivers email:

*

Your email:

*



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