MAIL IN REGISTRATION FORM

 

To register send the following information, along with your cheque or Visa Payment to:

 

Island Writers Association (PEI)

P.O. Box 1204

Charlottetown, PE   C1A 7M8

 

Please ensure mailed forms arrive well before the date of your event.  Pre registration ensures handouts

Name: __________________________________________________

Address:_________________________________________________

________________________________________________________

City: ___________________Prov. ________

Postal Code______________Phone: ________________

Email: _______________________________

 

Name of Workshop/s                                           Cost

_______________________________          ___________

_______________________________          ___________

Early bird discount rate (if applicable)            ____________

Payment enclosed in the amount of  $            ____________

 

Please make cheques payable to the Island Writers Association.  

 

TO PAY BY VISA, complete the following:

 

Signature:_______________________________

 

Name (as it appears on card - print):____________________________________

 

Visa number: ______________________________

Expiry Date: _________________________

Mail completed form and payment, to:

Island Writers Association (PEI)

P.O. Box 1204

Charlottetown, PE   C1A 7M8