WESLEYAN WRITERS CONFERENCE REGISTRATION	
	       Or Fellowship/Scholarship Application Form		  	          


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TITLE: DR., MR., MRS., MS.				NAME
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MAILING ADDRESS
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CITY							STATE			ZIP
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DAY TELEPHONE		EVENING TELEPHONE		     CELL PHONE
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E-MAIL ADDRESS


WRITERS CONFERENCE ONE-DAY FESTIVAL OF NEW REGISTRATION:

□  FESTIVAL OF NEW, JUNE 19. INCLUDES DAY & EVENING PROGRAM PLUS LIGHT LUNCH & DINNER.  
   Program cost-$150.00  (requires $75 non-refundable advance deposit)

□  1 night boarding available at additional cost of  $45

WRITERS CONFERENCE FULL WEEK REGISTRATION:

I WISH TO ATTEND THE CONFERENCE AS A:

□ BOARDING STUDENT         □ DAY STUDENT (full Program)          □ DAY STUDENT (tuition only)
	

□ MY NONREFUNDABLE DEPOSIT OF $75 IS ENCLOSED*. (The Balance is Due By:  May 23, 2008) 
 

MANUSCRIPT CONSULTATION:

__I AM REGISTERING FOR A MANUSCRIPT CONSULTATION.  I WILL SUBMIT:

  __NOVEL            __SHORT STORIES            __POETRY          __NONFICTION

MY MANUSCRIPT:		__IS ENCLOSED		__WILL BE SENT LATER (Due by May 11th)

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

	                     OR     2)	________________________________________
						(FACULTY MEMBER’S NAME)

SCHOLARSHIP/FELLOWSHIP APPLICANTS:

I AM APPLYING FOR :

__A SCHOLARSHIP   	 __A FELLOWSHIP	__BOTH  SCHOLARSHIP AND FELLOWSHIP
	
IN:      __FICTION    	__POETRY	__NONFICTION	__DAVIDOFF JOURNALISM

MY SCHOLARSHIP/FELLOWSHIP MATERIAL:    __IS ENCLOSED    __WILL BE SENT BY APRIL 5, 2008.

__I AM NOT SENDING A DEPOSIT (because I am applying for a scholarship or fellowship) OR

__I AM SENDING A DEPOSIT (Please complete registration information above)

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*MAKE CHECKS PAYABLE TO WESLEYAN UNIVERSITY. 

*To pay by credit card, contact us at 860-685-3604 or agreene@wesleyan.edu. or provide your card information below:

I am paying by Mastercard____  Visa____

Card Number____________________________

Three digit code on back of card (required by Wesleyan):____________  Exp Date_____

Amount paid here: $___________

Cardholder's full name: __________________________________

Billing address: _________________________________________

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Signature________________________________

How did you hear about the Wesleyan Writers Conference?
Please tell us the title or Website address if you can remember:

Brochure_______________   Newspaper_______________    Magazine_______________    
     Website Search_______________ Website/Email Advertising_______________


MAIL TO: 	WESLEYAN WRITERS CONFERENCE, WESLEYAN UNIVERSITY, 
		294 HIGH STREET, ROOM 207, MIDDLETOWN, CT 06459