Name: _______________________________________________________
Address: __________________________________________________________
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City: ___________________ State: ________ Zip Code:
________
Telephone: _______________________
E-mail: __________________
Which Seminar/workshop are you interested in applying for?
____________________________________________________________
____________________________________________________________
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Have you ever attended a writers’ workshop? ___ Yes ___ No.
If yes, when and where:
____________________________________________________________
____________________________________________________________
_____________________________________________________________
___________________________________________________________
Will you be participating in the Workshop? If so, what are your expectations of this workshop? What do you hope to come away with?
____________________________________________________________
____________________________________________________________
____________________________________________________________
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Tell us briefly about yourself (work interests, hobbies, etc.):
____________________________________________________________
____________________________________________________________
____________________________________________________________
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Do you want us to try to match you with a roommate?
_____ Yes _____ No
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