| JANUARY JUMPSTART X Bill Brown, Poetry Leader Edward Francisco, Fiction Leader January 15-17, 2010 |
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| REGISTRATION FORM |
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| Name: | ____________________________________________________ | |
| Mailing Address: | ____________________________________________________ | |
| City/State/Zip: | ____________________________________________________ | |
| Phone: | ____________________________________________________ | |
| Email: | ____________________________________________________ | |
| Please circle the items for which you are paying. |
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| Please mark the workshop you wish to attend: Poetry: ______ Fiction: ______ |
Workshop TMW and TWA Members: Non Members: Optional Catered Dinner: TWA Membership: TMWI Membership |
.....$100 .....$110 (workshop and membership) .......$15.50 .......$25.00 .......$10.00 |
| Amount Enclosed |
$ _________________ |
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| Mail to: | TMW/January Jumpstart 2010 P. O. Box 5435 Oak Ridge, TN 37831-5435 |
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| For additional information contact Sue Richardson Orr at theorrs@usit.net | ||