Discover Writing Seminars with Barry Lane

(you may register for any of Barry Lane's Seminars using this form
To register for Gretchen Bernabei's seminars, please click HERE)

Workshop Location and Date - Please select your choice
*required*required


Includes refreshments, handouts, and attendance certificate

 Note:  If you are using a company or school purchase order, please mail it to us before the seminar date.

DISCOVER WRITING COMPANY
PO Box 264
Shoreham, VT 05770

Please indicate the purchase order number here

School Purchase Order Number

Then complete the rest of this form as needed.

OR

I will be paying by (select one) *required
 Credit Card    Check Mailed to Discover Writing Company

If paying by credit card, please complete this information

Visa   Master Card

Credit Card No.

Expiration Date

If you are interested in CEU's etc. and they are available for your state,
all of the information will be provided at the seminar.
(a minimum of one registrant below is required to complete this form)

Registrant #1      Position/Grade   

Registrant #2      Position/Grade

Registrant #3      Position/Grade

Registrant #4      Position/Grade

Registrant #5      Position/Grade

School Affiliation

Street Address (School)          

City      State      Zip

Email

One of the attendees, please complete the following information.

Full Name *required

Home Address *required

Home City *required

Home State *required    Home Zip *required

Home Email

Work Phone *required      Home Phone *required

Number of people attending from your school or company

Please use this space for additional information or comments

Thanks for Registering - We look forward to meeting you!