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Class Registration Form

Please fill out all of the fields below. Use your browser's print button to print this form out and mail it to:

                          John Oliver Killens Writers Workshop Inc.
                          399 Halsey Street, Suite 100
                          Brooklyn, NY 11233-1014

I am interested in signing up for:

Beginning/Intermediate Class

Young Writers Program

Life Stories

* Name:

If applying for someone other than yourself

Name of Student:

* Address:

* Zip:

* City:

* State:

Fax:

* Phone:

* E-mail:

Please check here if you need financial assistance


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