2010 Writers' Conference Registration Form

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Print your name as you want it to appear on your name tag. Please print clearly.
Personal Information
SSN: How Your SS# Will Be Used
 _______-_____-_________   SDSU Red ID Number Get Your SDSU Red ID Number ______________________
DOB:
 Month____ /Day____ /Year______
Name:
 _______________________________________________________
Address:
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City:
 __________________________________  State: ____  Zip: __________
   
Day Phone:
 ______-______-________  Evening Phone:______-______-________
Fax:
 ______-______-________
Email: Email Address Information
_______________________________________________________
By checking this box, I give the SDSU College of Extended Studies permission to email me about upcoming courses and programs.
Course Requests

Noncredit Schedule No. 10SPWC 99701 XW

____ $365 through Jan. 5, 2010. Does not include consultation appointment or advance reading fees.
____ $399 after Jan. 5, 2010. Does not include late consultation appointment fees.

Editor/Agent Appointments (consultation appointments and advance reading appointments) limited to three appointments per paid participants. Rules apply, see Rules and Guidelines.

____ $40 each through Jan. 5, 2010
____ $50 after Jan. 5, 2010 (Consultations appointments only)
Note: Only consultations will be scheduled after Jan. 5, 2010. Advance reading appointment fees and submissions must be received no later than Jan. 5, 2010. No exceptions will be made.

Survey Information
Please enter the Source/Promotion code from the advertisement or publication from which you heard about our programs. This helps us measure the effectiveness of our marketing programs. Thank you.
Source Code Location


Payment Method
Payment Method (check one): ____Check ___Visa ___MasterCard (Amex & Discover are not accepted)

Credit Card Expiration Date: ____/________

Card #: ________-________-________-________         Total Amount Due: $ ______________

Signature: ____________________________________ I agree to abide by the deadlines and policies governing this conference.

Enclose payment payable to SDSU Research Foundation.
Mail to:

    SDSU Writers' Conference
    College of Extended Studies
    5250 Campanile Drive, Room 2503
    San Diego, CA 92182-1920