REGISTRATION
TEEN NOVEL WRITING WORKSHOP
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Name: _______________________________________________________________
Address :______________________________________________________________
City :____________ State: ________ Zip:_____________
DOB: ______________ Grade:_____________ School: _________________________
Home Phone _______________________ (Cell) _____________________
Email: ________________________________________________
Genre of Interest (i.e., young adult, mystery, fantasy, inspirational, crime, etc.)
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Have you written a novel or started one ? ___ Yes ____No
What would you most like to learn in this course? ___________________________
How did you hear about the course? ______________________________________
I understand that fees must be received to an expected to participate responsibly and maturely while in this course.
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Participant’s signature ____________________________ Print Name_____________________________ Date____________
Participant’s signature____________________________ Print Name______________________________ Date____________
Email Registration form to: sherylmallory-johnson@cox.net or call (619) 621-5684 for more information