Registration form

DEHeap Enterprises, Inc.
Exclamation! Publishers

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Registration form

REGISTRATION FORM
Please contact us for fax or mailing address.

Your organization name:

Printed name and title of conference or seminar organizer:

Please reserve the following date:
First choice:

Second choice:

Third choice:

Conference or seminar requested (circle one):

Evening with the White Rose (3-hour session)

Day with the White Rose (2 3-hour sessions)

Abandonment Reading (3-hour session)

White Rose Seminar (3 days)

White Rose Conference, Part One (5-1/2 days)

White Rose Conference, Part Two (5-1/2 days)

White Rose Conference, Part Three (5-1/2 days)

Shoah: German Resistance and the Jewish Community (3-hour session)

Historical Revisionism: Rewriting History (3-hour session)

Historical Revisionism: American News & World Report (3-hour session)

Inspired Writing (3-hour session)

Creative Nonfiction (3-hour session)

20th Century Democracy: Cynical Idealism (3-hour session)

Registration is not valid until deposit is received. 50% of remainder must be received no later than SIX weeks before the seminar or conference begins. Balance due TWO weeks before the seminar or conference begins.

Calculation of deposit: $________________ x "admission" x 15% = $_____________________

Cancellations within six weeks of seminar or conference are completely non-refundable.

I hereby agree to the above terms and conditions.

Signature of conference or seminar organizer:

Title:

Date:

Please note that we accept credit cards - MasterCard, VISA, and Discover. If you wish to pay with credit card, please complete below:

Name of credit card holder:

Street address:

Zip code:

Type of card: MasterCard - VISA - Discover

Card number:

Expires:

Security code:

I hereby authorize use of my credit card in payment of the above deposit for the seminar or conference requested.

Signature of credit card holder: