COURSE REGISTRATION FORM return to home page
 
Writing on Lake Siskiyou
Workshops for New & Established Writers
with Beth Beurkens, M.A.
 

Mount Shasta, California
July 3rd, 2008
Thursday, 10:00 AM - 2:30 PM

TUITION: $67-100 (flexible fee scale)

MORE INFORMATION: Call Beth Beurkens (530) 938-4777

TO REGISTER: Please send full fee with the completed information below to:

Beth Beurkens, PO Box 840, Mt Shasta, CA 96067

Enclosed is: $_____________($67.-$100 full fee)(nonrefundable) for Writing on Lake Siskiyou.

Name_____________________________________

Address______________________________email________________________

City_____________________ State_____ Zip__________

Phone_________________________

 

Liability Release Form

Date_____________________________

I will not hold Beth Beurkens legally responsible for any injury, illness, accident, or other misfortune that may occur in connection with enrollment in the Writing On Lake Siskiyou workshop on Thursday, July 3rd, 2008 on Lake Siskiyou, California.

Signature____________________________________________________________

Printed Name_________________________________________________________

Please mail with your check to: Beth Beurkens, PO Box 840, Mt. Shasta, CA 96067 When I receive your registration, I will send you a confirmation letter with directions and all other relevant information.

Questions? You can reach me at 530 938 4777: or email me at beth@shamanicuniverse.com