Writing Workshops for Adult -Application form

Writing Workshops for Adults
Date

MonthDayYear
Date
Full Name of Writer*

First NameLast Name
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.

YESNO
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):

The Joy of Words: Writing Salon, Sat 1 Feb to Sat 1 Mar (5 weeks) 9.30-11.00am
Fees, Discounts and Payment
PROMO CODE
Discount
Total
HST (13%)
Total Incl 13% Tax
Credit Card Payment

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CADDescription
Authorization
Please read:
Booking conditions
I have read, understand and agree to the 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.*

YES
Communication

Please add me to your email list to receive communications about news and events
QUESTIONS? Call 416 766 7124

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

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Writing Workshops for Adults