Paper Cuts Poetry Workshoop

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Please fill out this form to register for the Paper Cuts Workshop. You may include your credit card information or bring/mail a check before the first day of class to Emerson Preparatory School, 1324 18th Street, NW, Washington, DC 20036 ATTENTION: PAPER CUTS WORKSHOP.

Student Name *

Student email address

Parent Name *

Parent email address

Home Phone Number *

Parent's cell phone number

Student's cell phone number

How did you hear about Paper Cuts or EmersonPrep? *

Tell us a bit about your interest in poetry

You may write a paragraph or a little more if you'd like.

Student Age *

Method of payment *

Indicate how you will pay the $250 workshop fee. The fee is due before the first day of class. We do not accept American Express directly but our payment vendor Paypal does.

VISA Credit Card

Mastercard

Paypal (For this option, you must provide an email address so we may invoice you)

Check or cashier's check (please mail to 1324 18th Street, NW, Washington DC 20036, ATTENTION: Paper Cuts Workshop)

Required

Credit Card Number

Credit Card Expiry Date

Three-Digit Security Code on back of Credit Card

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