Registration Form

* = required field

Personal Information
Title
First Name*
Last Name*
Street Address*
City*
State*
Zip/Postal Code*
Email Address*
Phone (please include only one phone number)
Home Phone
Office Phone
Cell Phone
Professional Information
Position Title
Institutional Affiliation
Profession
Registration Information
Registration includes admission to both keynote speakers, Friday night Poetry Slam sponsored by ArtHaus, all panels and readings on Saturday, as well as Festival Reception on Friday and Festival Dinner on Saturday prior to Lamott reading. Please note: Lamott's presentation is free and open to the public. Festival attendees will have reserved seating in the front section of the hall.
Please describe any dietary restrictions and needs
Payment Amount*
Note: Early Registrants (before Sept. 10) will have their names placed in a drawing to be guests at the small dinner for Mark Salzman following his reading.
Please note any questions you have about this Registration form
Payment Method
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Credit Card Number*
Expiration Month*
Expiration Year*
Name as it appears on card*
Billing Street Address*
Billing City*
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Billing Zip/Postal Code*
Billing Country