Oregon Coast
Children’s Book Writers Workshop

Publish a Middle Grade / Young Adult Novel!

INTENSIVE ONLINE COURSE

Registration and Tuition

Please complete the following form and click on the "Register Now" button to register for the Publish a Middle Grade / Young Adult Novel! Intensive Online Course.

You must also:

• Print, fill out, and submit an Agreement Form.
• Make payment for the course using one of the following options.

1. Email by scanning the completed Agreement Form to David Greenberg at authilus@teleport.com and make payment electronically through an online service such as PayPal, Zelle, or Venmo. This is preferred.

OR...

2. Mail a check made payable to David Greenberg along with the Agreement Form to:
   

   Publish a Middle Grade / Young Adult Novel!
   7327 SW Barnes Rd., PMB 623
   Portland, OR 97225

If you have any questions, please e-mail David Greenberg at authilus@teleport.com.

*Required Information

*Title:	Mr.   Mrs.   Ms.   Miss   Dr.
*First Name:	Middle Initial:
*Last Name:
*Street Address 1:
*Street Address 2:
*City:
*State:
*Zip:
*Country:
*Phone:
*E-Mail Address:
*Today's Date:
*Tuition:	$595 each: One Person $575 each: Two People who register at the same time $545 each: Three People who register at the same time $525 each: Four to Nine People who register at the same time $495 each: Ten People or More who register at the same time
	If you are registering with one or more people, please list their names below. Each person will need to register separately.