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___________________________

4/6/2010 We're currently having issues with snail mail. Please e-mail president@oirw.net with your
request to register via snail mail and we'll get instructions to you.
We appreciate your patience while we work the kinks from the system.

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

Outreach International CAMPUS
c/o OIRW Treasurer
PO Box 531541
Cincinatti, OH 45253

All checks or moneyorders should be made out to: Outreach International Romance Writers

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______________________________________