SEAK, Inc. Medical Fiction Writing For Physicians 2004
 REGISTRATION FORM

To register, call SEAK, Inc. at 508-457-1111, or PRINT this form, complete the requested information (neatly, please), and FAX to SEAK, Inc. at 508-540-8304, with credit card information. 

Or mail with credit card information or check to:   SEAK, Inc. PO Box 729, Falmouth, MA 02541

priority code: Net

Please register me for:


_____MEDICAL FICTION WRITING for PHYSICIANS (September 11-12, 2004)  $995.00

Preconferences - Friday, September 10, 2004

_____ Nonfiction Writing For Physicians (September 10, 2004)  $395.00

_____Getting Your First Novel Published (September 10, 2004)  $395.00

_____Screenwriting For Physicians (September 10, 2004)  $395.00

 

  Check Enclosed   
  Credit Card Billing -- Type of card: ___Visa ___MC ___AE
Card No.

 

Exp. Date:
Signature

 

Please print or type all information. Use abbreviations as necessary.

Name                                                                                                                                                              Title
Name of Organization
Address

 
City                                                                           State                        Zip
Phone (Area Code/Number)                                       Fax
E-Mail
Specialty

SEAK, Inc. FAX  (508) 540-8304

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