IMAGES AND RHYTHMS REGISTRATION FORM

(Print out page and print information below clearly, please)

Name ___________________________________________________________________________

Address _________________________________________________________________________

City ______________________________________________________ State ____  ZIP _________

Phone _________________________email______________________________________________

We cannot guarantee your workshop choice. Workshops will be filled in order of registrations received. So please indicate your 1st, 2nd, and 3rd workshop choices by putting the numbers 1, 2 and 3 in the appropriate boxes.

□ Mary Jo Firth Gillett workshop

□ Judith Minty workshop

□ Josie Kearns workshop

□ Diane Seuss workshop

□ Phillip Sterling workshop

□ Keith Taylor workshop

□  I am paying by enclosed check for $150 payable to Ludington Visiting Writers

□  I have paid $150 through PayPal

Mail to:

Ludington Visiting Writers

Ludington Area Center for the Arts

107 S. Harrison St.

Ludington, MI 49431