Freewrite Workshop Registration "*" indicates required fields Name* First Last Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email* PhoneEmail* Email* How did you hear about this workshop? Please choose the workshop you'd like to register for:*Your workshop fee directly supports our free writing workshops in low-income housing communities, correctional facilities, hospitals, schools, treatment centers and other social service agencies. For a free spot, please email freewrite@writearound.org.Thursday, April 18 2024, 6:00-7:30pmThursday, May 23, 2024 6:00-7:30pmThursday, June 20, 2024 6:00-7:30pmTotal Credit/Debit Card Information American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Expiration Month010203040506070809101112 Year Expiration Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name * I have read and agree to the Registration, Cancellation, and Refund Policy. HiddenHave you been previously or currently involved with us? Check all that apply: Volunteer Donor Partner Prompt/HOTLIPS Pizza writing workshop participant Writing Workshop participant I’m new to you! Other HiddenConfirmation I confirm that I am over 18 years of age (if under 18, do not submit this form; contact our Program Director at sweller@writearound.org or call 503-796-9224).
