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 |
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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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