Workshop Registration Slip

Workshop Title	Introduction To Creative Writing
Workshop Date	[Date]
Location	[Your Address]
Registration Fee	$50 (Payment instructions on the reverse side)

 

Participant Information

 

Full Name	[Your Name]
Email Address	[Your Email]
Phone Number	[Your Phone Number]
Address	[Your Address]
City	Boston
State	Massachusetts
Zip	02108
Emergency Contact Name	[Your Name]
Emergency Contact Phone	[Your Phone Number]

 

Additional Information (Please check if applicable):

 

•   I have dietary restrictions or allergies. Please specify: _______________

• I require special accommodations (e.g., wheelchair access, ASL interpreter). Please specify: _______________

• I would like to receive updates and promotions from Future Writers Academy via email.

 

Terms And Conditions

 

1. Payment: Registration fee is due upon submission of this form. Payment instructions are provided on the reverse side of this slip.

 

2. Cancellation Policy: Cancellations made 7 or more days before the workshop date will receive a full refund. No refunds will be issued for cancellations made less than 7 days before the workshop.

 

3. Liability: FutureWriters Academy and the Elmwood Community Center are not responsible for any personal injury or loss of property during the workshop.

I have read and agree to the terms and conditions stated above.

 

Participant's Signature: [Your Signature]

Date: [Date]

 

For Office Use Only:

 

Payment Received:

 

• Yes

• No

 

Amount: $ [Amount]

Date: [Date]

 

Confirmation Email Sent:

 

• Yes

• No

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