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Name: _________________________________________________ Address: _________________________________________ Email: ___________________________________________ Primary Phone Number: _____________________________ Secondary Phone Number:__________________________________________ Course Name and Dates:____________________________________________ Payment Method (please circle): Check, PayPal, Money Order Amount enclosed: ___________________________________ Hampton Roads Writers P.O. Box 7607 Norfolk, VA 23509-0607 *PLEASE NOTE: If less than 10 people register for a class, it will be canceled, and your money will be refunded. |
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