PLEASE PRINT THIS FORM;COMPLETE IT & MAIL REGISTRATION FORM FOR WRITING YOUR LIFE STORY NAME:_________________________________________ ADDRESS: ________________________________ CITY, STATE: _________________________________ ZIP: _________________ E-MAIL: _______________________________________ PHONE: (____)_______________________ FAX: (____)__________________ **************************************************** HERE'S WHAT YOU GET WHEN YOU REGISTER: - Instruction Booklet "How To Write Your Life Story" - Opportunity to communicate with program leader up to two times each week via e-mail. - Opportunity to submit up to 12 pages of your writing each week for review and critique by program leader. - Personal attention and help with your story. - FREE newsletter. ***************************************************** PROGRAM FEES $15.00 per month (first three months) $12.00 per month (additional months) Please Note: Minimum initial registration period is for three months at a total cost of $45.00. Payment for this amount must be included with this registration form. Only checks or money orders can be accepted. After the first three months, you may sign up and pay on a month to month basis. Please make all checks or money orders payable to "Writing Your Life Story". MAIL REGISTRATION FORM AND PAYMENT TO: Writing Your Life Story Attn: Jenny P.O. Box 58170 Cincinnati, OH 45258-0170