Birdland Writing Retreat Registration

Birdland Summer Writing Retreat                               

Date: August 4, 2012

Registration Form                                           

Name ______________________________    

Address ____________________________    

City, State, Zip ______________________      

Phone ______________________________    

Email_______________________________     

Lunch included--Please select your Choice
__Ham and Cheese Wrap
__Turkey and Cheese Wrap
__Veggie and Cheese Wrap
(These options are also available without cheese.)
Please list any food restrictions (vegetarian, vegan, allergies, etc.) ___________________________________________
                            

Please return registration form                       

and personal                                                

check payable to Birdland Book Arts 

• Early Bird price: $45
• $55 after July 14th (Postmark date)

• to:                                                        

                                                                   

Birdland Workshop —Mary Lucille Hays       

1185 E 1900 North Road                          

White Heath, Illinois 61884                   

                                                                                                                            

Limited scholarships available. Email for details.


(Note: You may also cut and paste this form and send it in an email to letterfrombirdland@gmail.com and use the PayPal donation button for the fee. Add $1 to cover PayPal charges.)