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REGISTRATION FORM
Summer & Fall Reading Retreats, 2016
Aug. 25-28, Sept. 8-11 and Oct. 6-9

Please sign me up for the 2016 Reading Retreats.

Name_______________________________________________________________________

Address____________________________________________________________________

City________________________ State ________ Zip ____________________

Phone with area code___________________

My session preference: Check the session you wish to attend; if you're flexible, number the sessions in order of preference.

____ Aug. 25-28 ____ Sept. 8-11 ____ Oct. 6-9

I plan to attend with ______________________________________

My deposit

______ My check for $100 is enclosed (made out to Minnesota Women's Press)
______ Please charge the $100 deposit to my credit card

Kind of card: ____ Visa _____ Mastercard _____Discover

Name on card: ______________________________________________

Number on card: ____________________________________________

Expiration date: ________ Security code (3 numbers on back): _______

Room preference (Rooms will be assigned in order of request; we try to accommodate requests when possible.)

_______ I'd like to room with _________________________________________

_______ I'm open to sharing a double room with anyone.

_______ I'd prefer a single room if available.

Mail this form within three weeks to:

2016 Reading Retreats,
Minnesota Women's Press
970 Raymond Ave., Suite 201,
St. Paul MN 55114



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