WritersUA Conference | Registration Form

Online registration with a credit card payment continues through Tuesday, September 6.

Online registration is very easy. All we need is your contact information and payment method. If you are registering more than one attendee, please fill out one form for each person.

Contact Information

Please fill out this section completely
First Name	Last Name
Organization	Email Address
Address with City, State or Region	ZIP/Postal Code
Country (if not U.S.)	Phone Number

Conference Payment

The Conference fee is US $1,125 (including VAT), which includes admission to all sessions, a networking lunch, comprehensive printed proceedings, and continental breakfasts. For this event we are requiring credit card payment. We accept American Express, VISA, MasterCard, Discover, and Diners Club. Please provide your credit card account details below. If your credit card receipt should be sent to an address that is different from the address in the Contact Information section of this form, please enter that address here.

Credit Card Information
Cardholder Name	Account Number
Receipt Address with ZIP/Postal Code	Expiration Date

Cancellation Policy

For cancellations received by August 15, 2004, we will refund your fee less $100 for administrative expense. No refunds will be granted for no-shows and cancellations received after August 1. We accept substitutions at no extra charge with written notice prior to August 20.

Send Form

Once you have completed this form, click Send Form. Be patient—it may take 30-45 seconds until you receive confirmation that your input was accepted. You will receive a personal email from one of our staff with your credit card receipt and additional details regarding this event.