NAME:

ADDRESS:

DATE OF BIRTH:

CONTACT NUMBER: (W)
                             (H)
MOBILE:

EMAIL:

If you would like to attend the THE ABC OF WRITING A SCREENPLAY workshop in Cape Town on MAY 4, 11, 18 and 25, 2013 from 2pm until 5pm the cost is R950.
   
If you would like to attend THE WRITE VOICE creative writing workshop in Cape Town on JUNE 1, 8, 15, 22, 2013 from 10am until 1pm the cost is R950.

DEPOSIT THE REQUIRED AMOUNT INTO THE ACCOUNT or INTERNET TRANSFER:
Account name: D.E.Dercksen (Sole Proprietor trading as The Writing Studio)
Standard Bank - Kromboom Branch
(Branch code 026209)
Savings Account number: 27 550 5618
TAX NUMBER: 061 708 2151

PRINT, THEN FAX SIGN UP FORM AND DEPOSIT SLIP TO:   086 759 3291  or email deposit details to info@writingstudio.co.za

This confirms that ………………………………………………………………………………………………...   will attend

________________________________________________________________


SIGNATURE OF PERSON RESPONSIBLE FOR FEES
DATE: