Young People's Summer Writing Workshop Registration

Summer 2011


Sign up for July 11th to July 15th.
Tuition is $250 per child for the week.
Registration Deadline is Friday, June 18th.
Should you have questions about the workshop, feel free to contact me at dionisiom@mville.edu or 914-329-3527.

*Required Fields
Parent/Guardian:
Please enter your name and address as they appear on your credit card.
First Name   *
Last Name   *
Home address   *
Home address 2    
City   *
State/Province   *
Zip Code   *
Home Phone   *
E-mail   *
Your Child
Child's First Name   *
Child's Last Name   *
Child's Grade in September 2011  
All participants
receive a
YPSWW T-shirt.

Please specify
your size:
Kid's Medium
Kid's Large
 Adult Small
Adult Medium
Adult Large
Adult XL
Payment
Your credit card will be charged $250.00
Card Type   *
Credit Card #   *
  (numbers only, no spaces or dashes, etc.)
Expiration        *
Card Security Code   *
The security code appears on the front of
American Express cards (4 digits),
and on the back of other cards (3 digits).
Submit
  I wish to submit my registration. I understand that the credit card described above will be charged $250.00 for this workshop.
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  I wish to start over.