Enrollment
Form , RFPF Workshop
Your Name:
Street Address:
City, State:
Zip Code
Phone Number
E-mail address:
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join our mailing list for events
Credit Card :
Mastercard
card type:
VISA
Expiration Date(mm/yyyy)
Card Number:
Credit Card PIN number
(3 digit number on the back of the card in the signature
area)
If the name on the card or
the billing address is different from above, please
provide:
Name on Card:
Billing Address:
I
prefer to pay by check or money order
(Please print out this form and mail with payment to
the address listed below)
Please select the
appropriate registration fee for the Workshop:
Poetry Workshop Registration Fee
Early
Registration, before March
1st, 2008 $125.00
Standard
Registration $150.00
(Please note: All cancellations after April 10th 2008 will incur a
$100.00 fee)
Please confirm that your information is
correct then press the submit button below.
Please, press only once to avoid duplicate orders. Thank
You!
Additional request
or comments
You may enroll online and pay by credit card by
filling out this form and clicking the "submit"
button.
If you prefer to pay by check or money order, please fill out
and then print the form,
and mail it with your check or
money order to :
RFPW Workshop,
Heritage House Museum
410 Caroline Street ,
Key
West, FL 33040
E-mail:
info@heritagehousemuseum.org
( 305)
296-3573
Thank you!