Writing Workshops for Adult -Application form

Writing Workshops for Adults
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Full Name of Writer

First NameLast Name
I am...
Your Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email
I authorise Centauri Arts to share this email address with other members of the writing group so that we can share excerpts of our writing with one another.
Cell Number
Tell us a little about your current writing project, if you have one. What do you hope to achieve in our writing classes?
Where did you hear about Centauri Arts?
Choose your workshop(s):
Prices:

Half Day workshops $45+HST
4 week course: $159+HST
5 week course: $199+HST
6 week course: $239+HST
Location:
Fees, Discounts and Payment
PROMO CODE
I teach at this school:
Occupation

Other
Discount
Total
HST (13%)
Total Incl 13% Tax
Payment Method
Credit Card Payment

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CADDescription
Authorization
Please read:
Booking conditions
ELECTRONIC SIGNATURE: I certify the information provided is true and correct, and legally obligate myself to the same extent as I would by signing my name on a printed version of this form.
Communication
QUESTIONS? Call 416 766 7124

CONFIDENTIALITY OF INFORMATION:
Information collected on this form will be used for Centauri Arts purposes only.

Debit or Credit Card

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Writing Workshops for Adults