MedFicWrFax
 

                                               SEAK, Inc. Medical Fiction Writing For Physicians 2005
                                                    REGISTRATION FORM
To register, call SEAK, Inc. at 508-457-1111, or PRINT this form, complete the requested information (neatly, please), and FAX to SEAK, Inc. at 508-540-8304, with credit card information.  Or mail with payment to:  SEAK, Inc. PO Box 729, Falmouth, MA 02541

                                                                                                                                                                                                                                            priority code: Net

Please register me for:

Main Conference
___6th Annual Medical Fiction Writing Workshop, October 21-23, 2005 ($995)

Preconferences

___ The Secrets to Writing a Best-Seller, October 20, 2005 ($395) ___ Non-Fiction Writing for Physicians, October 21, 2005 ($395)
___ How to Write a Medical Memoir, October 20, 2005 ($395) ___ Screenwriting for Physicians, October 21, 2005 ($395)
___ Medical Fiction Writing: Breaking Through, October 21, 2005 ($395)

___ How Physicians Can Get Their First Novel Published, October 21, 2005 ($395)

1  Check enclosed payable to SEAK, Inc.                1Visa                1Mastercard                  1American Express

Account Number:_______________________________________________  Expiration Date:_____/______

Signature:_____________________________________________________

Please print or type all items to assure accuracy. All confirmations will be sent to the individual indicated.

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First Name (as it will appear on badge)                                                            Last Name

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Title                                                                                                   Email

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Name of Company or Organization

__________________________________________________________________________________________________
Specialty/Area of Expertise

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Mailing Address

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City State Zip

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Phone (Area Code / Number) Fax (Area Code / Number)
 

© SEAK, Inc. PO Box 729 Falmouth, MA 02541 Phone: 508.457.1111 Fax: 508.540.8304 Email: Mail@seak.com