Name:_____________________________________________________________
     ^{(Last)                 (First)                       (MI)}
Street Address:___________________________________________________

City/State/Zip:___________________________________________________

County:______________________ Social Security Number:_____________

Phone: (Home)_____________________________________________________

       (Business)_________________________________________________

Hotel Stay While in Augusta:______________________________________

For how long?_____________________________________________________

Payment of Conference Fees

I have enclosed a check_______ Or money order ___________
Make checks payable to: Augusta State University Sandills Writers Conference

Charge to my Mastercard____________ Or Visa______________

Card Number:_____________________________________________

Expiration Date:_________________________________________

Cardholder's Name:_______________________________________

Signature:_______________________________________________

Telephone Order/Date:____________________________________

Check each that applies to you:
_____ $156 Full Conference Registration received by February 8, 2008

(See earlier scholarship deadline)

_____ $76 Full Conference Student Registration received by February 8, 2008

(See earlier scholarship deadline)

_____ $33 Each additional manuscript submitted   $33x____

_____ $110 Conference Only Registration - No manuscript submission

_____ Daily Registration - no manuscript submission
           ____ $55 Thurs.    _____ $ 55 Fri.   ____ $25 Sat.

_____ Total
 

_____ Check here if printed out this form via the Sandhills webpage