Registration Form

1st Annual NOVA-Woodbridge Writers’ Retreat

Woodbridge Campus, NVCC
15200 Neabsco Mills Road
Woodbridge, VA. 22191
May 18th—21st 2011

Full Name: _______________________________________________ (First name for badge)____________________________

University/Organization: ___________________________________________________________________________________
Preferred Mailing Address:__________________________________________________________________________________
City: ________________________________ State/Province: ______________________ Zip/Postal Code: _________________
Telephone: (______)__________________ Fax: (______)____________________Email:___________________________
Student ID #________________ (If you have not been a Virginia Community College Student in the past three years, Click the link
below to apply and receive a student ID#):

https://apply.vccs.edu/oa/launch.action: follow the procedures listed there as “new user,” and select “Non Credit” for type of classes
you will be enrolling. Once you have a Student I.D.# write it in the space above and continue with this form.

Conference Registration fees (Choose one option):

1) $250.00 Includes reception, 3 days of workshops, 2 to 4 craft talks, four readings.

2) $325.00 Includes reception, 3 days of workshops, 2 to 4 craft talks, four readings, plus Thursday and
Friday lunches (Dinner on your own) and Welcome Banquet (Wednesday).

PLEASE CHECK APPROPRIATE WORKSHOP: (ONLY CHOOSE ONE)

 Short Story Workshop, LLRN 1879 (Richard Bausch)
 Memoir/Non Fiction Workshop, LLRN 1880 (Randall Kenan)
 Novel Workshop, LLRN 1881 (Jill McCorkle)
 Poetry Workshop, LLRN 1882 (Alan Shapiro)
All Manuscripts (2-5 poems , fiction or essay, 15 pages max) must be sent with this form by April 1 st 2011.

TOTAL ENCLOSED: $ ____________

If you would like to act as a driver/host. Please check  (Note: Driver/Hosts pick up and return writers to the airport, drive to and from
hotel & workshop location and or restaurants, etc. Volunteers accepted on a first come first served basis.)

Cancellations/Changes and Refunds: For Refund policies and procedures please go to: www.nvcc.edu/wdce/pwregional

PAYMENT METHOD:
Check, Money Order or credit card. Checks & Money Orders must be in U.S. funds payable to: NVCC.
Registration confirmation/receipt and further information will be mailed.
For credit card payment, please call 703-257-6634. DO NOT INCLUDE CREDIT CARD INFORMATION ON THIS FORM.

Please mail completed registration form with payment to: 2011 Woodbridge Writer’s Retreat
Phone: (703) 878-5718 Office of Continuing Education, NVCC
15200 Neabsco Mills Road,
Email: rbausch@nvcc.edu Woodbridge, VA. 22191
Novawritersretreat@gmail.com