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REGISTRATION FORM:

Please fill out all of the information below. Boxes marked with * are required fields and the form will not be sent without that information complete.

If you have a problem with this form, send an e-mail with the required information to writersinthemountains@gmail.com.

1. Tell us about your self..
FIRST NAME*  LAST NAME* TITLE
2. Address Information
ADDRESS
CITY STATE
ZIP CODE
3. How can we reach you?
HM PHONE*
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4. I would like to register for:

“FOOD FOR THOUGHT” with ANN EPNER; Mondays , March 1 – April 5, Six sessions from 10 AM to Noon at the Fairview Library, Margaretville, $65

'WILD MIND' with ELLEN STEWART – Tuesday, April 13 – May 18, Six sessions from 10 AM to noon at theFairview Library, Margaretville   $75

PLAYWRITING WITH PHIL POTAK – APRIL 27 & MAY 4,  7 – 9 PM. Roxbury Arts Group, MAY 11 & MAY 18, 7 – 9 p.M. 76 MAIN, Stamford.  Special Fee  $25

“WHAT MAKES A NATURE POEM?” with LYNN DOMINA, Wednesday, May 19–June 23, six sessions from 6–8 PM; Andes Library, $75

 WEEKEND WARRIOR” WITH JENNIFER KABAT – In-depth fiction writing weekend, Saturday, May 22 & Sunday, May 23 from 10 AM - 4 PM    Fairview Library, Margaretville  Special Fee $25

"JOURNALLING" WITH EV ELLSWORTHTuesday, June 1 – July 6, six sessions from 10 AM – noon at roxbury Arts Group, Walt Meade Gallery, Roxbury     $65

"JOURNALLING" WITH EV ELLSWORTHWednesday, June 2 – July 7, six sessions from 10 AM – noon at RAG's 76 MAIN, Stamford   $65

"CRITICS CORNER" WITH BARBARA APOIAN, Thursday, July 15– August 19,six sessions from 6 – 8 PM. At Roxbury Run Village Clubhouse, Roxbury  $65

"CRITICS CORNER" WITH BARBARA APOIAN, Tuesday, July 20 – August 24, six sessions from 10 AM – noon at Fairview Library, Margaretville   $65

SHORT LYRIC POEM – WITH BARRY SEILER, Saturday, August 14 – September 18, six sessions from 10 AM – Noon  Roxbury Library, Main Street, Roxbury    Special Fee  $25

"PARENT and CHILD” WITH ANN EPNER,Thursday, September 16 – October 21, six sessions from 1 – 3 p.m. At Roxbury Arts Group, Walt Meade Gallery    $65

“WHAT'S TRUTH GOT TO DO WITH IT?” WITH BETHANY LYTTLE – Creative Non-Fiction  – Saturday, October 16 & Sunday, October 17 -   10 AM. - 4 PM. Roxbury Arts Group   Special $25

(For information regarding available scholarships to attend WIM workshops, click here)


*All personal information submitted on this form is for the exclusive use of Writers in The Mountains and will not be shared with any other company for mailing purposes! Statistical information could be used for Grant applications and funding purposes.

BE SURE YOU FILLED OUT YOUR NAME AND PHONE NUMBER BEFORE YOU SUBMIT!

Writers In The Mountains requires payment before the beginning of your workshop. Upon registering, you will be contacted regarding payment. You may mail a check made out to Writers In The Mountains to the address below in the amount of your fee. Be sure to note the workshop for which you have registered on the memo line of your check.

Our Mailing Address is:
Writers in the Mountains
PO Box 474,
Roxbury, NY 12474

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