OUTREACH INTERNATIONAL ROMANCE WRITERS

ONLINE CAMPUS MAIL-ONLY REGISTRATION FORM


*All fields must be filled in. Failure to do so may result in delay of registration.

Class Title:_______________________________________________

Name: (print clearly)_________________________________________

Current OUTREACH Member  YES____  NO____

Phone:__________________________

Email (print clearly)____________________________________

Alternate Email: (print clearly) ______________________________

Payment amount enclosed___________________________


Print this page and send with completed form and payment to:

Outreach International CAMPUS
CAMPUS Coordinator
606 Greenwich Place
Round Rock, TX, 78664

INTERNATIONAL registrants send US BANK/PAYPAL transfers ONLY--checks will be returned.

I have read and agree to the Policy & Procedures for Outreach Online CAMPUS.


Signature______________________________________