ADVANCE REGISTRATION - CAJ Freelance Event

Click your browser's Print button to print this form, which you may then
complete and fax to (613) 725-0570.

Tuesday, June 3, 2003 - National Press Club Library - Ottawa - 5 p.m. to 8 p.m. 

Panel Presentation begins at 6:30 p.m. - Buffet Lunch Provided - Cash Bar

(Press Club Entrance: Booth Building, 165 Sparks Street — on the Sparks Street Mall,
just west of O'Connor. Take elevator or stairs to second floor. Press Club door is 
right in front of the elevators on the second floor.)

Name:
_________________________________

Address:
______________________________________________

City:_____________________    Prov: _____________  Post Code:________________

Phone-home:_________________	Work:______________

Fax:____________________   E-mail:___________________

Employer/School: __________________________________

Work address: _____________________________________


$10 Member of (check all that apply) _____CAJ,  _____Writers Deadline, 
_____PWAC,  _____OIW, _____CWC, _____Media Club of Ottawa, _____National Press Club,  
_____Editors' Association of Canada, _____ Valley Writers Guild, 

$12_____ Not a member of any the above

If you have not registered in advance, the prices will be $12 for members of 
one of the listed groups, $15 for non-members.

SELECT METHOD OF PAYMENT:

___ Charge my Visa      ___Charge my MasterCard

Card # _______________________________________  Exp. date_____/_____

Signature_____________________________________


HAVE YOU COMPLETED ALL SECTIONS OF THE FORM?  SEND COMPLETED APPLICATION
FORM TO: (613) 725-0570

(Keep a copy of this form for your records)

Questions?  

Email: caj_ottawa@yahoo.ca  Subject: Freelance_Evening

Phone: Leave a voice-mail message at 725-6279 
(Message line courtesy First Stage/Sussex Place - if you hear their
 answering message, you have dialed correctly.)