Please complete the form below to register for the Maui Writers Conference. One Registration Form Per Person. The name provided on the form must be used on all material submitted to MWC. No pen names please. * Indicates required fields

Attendee Information

*First Name MI *Last Name *Address (include suite or apartment number) *City *State Select StateAlabamaAlaskaAlbertaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLabradorLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthwest TerritoriesNova ScotiaOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVirgin IslandsVirginiaVermontWashingtonWest VirginiaWisconsinWyomingYukon TerritoryOther              *Zip Code *Country *Phone Number (ex. 000-000-0000) *E-mail Address (a confirmation email will be sent to this address) *Confirm E-mail Address (please re-enter your email address for verification)

Conference Registration Options

A La Carte Conference Registration - $395 Lowest Registration Rate Offered   Conference registration - $395 Special Events Badge - $50     Name of Guest: Rupert Hughes Prose Writing Competition - $50/entry     No. of Entries: 1 2 3 4 5 6 7 8 9   One-on-one consultations with agents and editors - $40. Sign up at the Conference on space available basis. Retreat Discount   I am registered for the 2009 Maui Writers Retreat and am eligible for a $55 discount

Registration Total

Your Conference Registration Total:

Payment Information

Pay Online (complete form below) Pay via Phone/Fax - Call 1-808-879-0061 or faxed credit card information to 1-808-879-6233 *Cardholder's Name exactly as it appears on credit card *Cardholder's Phone Number (ex. 000-000-0000) *Card Type Visa MasterCard *Card Number *Expiration Date 010203040506070809101112 / 2008200920102011201220132014 *Verification Code (three digit code on back)

Cancellation and Refund Policy

Requests for refunds of the Conference fee must be submitted in writing, by mail or fax, to the Maui Writers Conference.  A $75.00 cancellation fee will be charged for refund requests received by July 1st, 2009.  After July 1st, 2009, a $150.00 cancellation fee will be charged.  There will be no refunds after August 15th, 2009.  Refunds will be credited to your credit card account six weeks after they are requested.  Maui Writers Conference reserves the right to change or cancel any speaker and/or session without notice. I understand and agree to the Cancellation and Refund Policy.