WESLEYAN WRITERS CONFERENCE REGISTRATION




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NAME:	DR., MR., MRS., MS.


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ADDRESS


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CITY	STATE	ZIP


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DAY TELEPHONE	EVENING TELEPHONE


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E-MAIL ADDRESS


* I AM REGISTERING FOR A MANUSCRIPT CONSULTATION. I WILL SUBMIT (UNDERLINE ONE):

NOVEL • SHORT STORIES • POETRY • NONFICTION

I WOULD LIKE MY WORK READ BY 1)	________________________________________
			(FACULTY MEMBER'S NAME)     

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		OR 2)	(FACULTY  MEMBER'S  NAME)

MY MANUSCRIPT	~	IS ENCLOSED	~	WILL BE SENT LATER


* I AM APPLYING FOR 	A SCHOLARSHIP___~    	A FELLOWSHIP____

     IN      __ FICTION	__POETRY	__NONFICTION     __DAVIDOFF JOURNALISM
Scholarship/fellowship materials (sample of work and letter of interest) __ are enclosed __will be sent later


* I WISH TO ATTEND AS A    ____BOARDING STUDENT	____DAY STUDENT

* I REQUEST AN UPGRADE TO AN AIR-CONDITIONED ROOM IF AVAILABLE. SURCHARGE: $30 FOR THE WEEK.



--MY NONREFUNDABLE DEPOSIT OF $75 IS ENCLOSED. (THE BALANCE IS DUE BY Friday, May 27, 2005)  
   
MAKE CHECKS PAYABLE TO WESLEYAN UNIVERSITY. 
   Contact us at  (860) 685-3604  or agreene@wesleyan.edu to make a Visa or Master Card payment.

-- I AM NOT SENDING A DEPOSIT BECAUSE I AM APPLYING FOR A SCHOLARSHIP OR FELLOWSHIP.


MAIL TO: WESLEYAN WRITERS CONFERENCE, WESLEYAN UNIVERSITY,  MIDDLETOWN, CT 06459