Name: 

Address: 

City/Town:     State:     Zip: 

Daytime Phone: 

Evening Phone: 

E-mail: 
 

Manuscript Type:  Choose One... Short Story Poetry Novel Chapter (with Outline) Other

I am most interested in:  Select a Workshop... Short Fiction Poetry Novel Tutorial Memoir Writers' Retreat - Room & Board Only

I will attend as a:   Board Student    Day Student

I will need transportation ($40 per trip) to/from:   None Syracuse Airport Syracuse Bus/Train Station Utica Bus/Train Station

  I am interested in applying for fellowship assistance.

  I am a CWC alumnus/a from
-or-
  I was referred by a CWC alumnus/a:
-or-
  Neither