Name: _____________________________________________________________________________
(If SCBWI member your name should be written exactly as it appears on your membership card)

Adress: ____________________________________________________________________________

Phone: _________________________________ E-mail: _________________________________

Please check all that apply:
1. I am a/an:
writer_____ illustrator__ critique group leader______
2. I am interested in:
YA Novels______ Middle Grade______ Picture Books______
Poetry______ Non-Fiction______ Magazines____Other__________
3. Saturday Box Lunch:
Turkey____ Roast Beef____ Vegetarian____
4. Saturday Dinner:
Would you like a vegetarian dinner? Please check here______
5. Sunday Workshops
Workshop 1: (Choose One) A____ B____ C___ D___
Workshop 2: (Choose One) E___ F___ G____ H___ I___

Conference Fees for Friday, Saturday, and Sunday:
______ Writers’ Intensive, (please make this a separate check) $125.00
______ Early Registration, SCBWI member: $225.00
______ Early Registration, non-SCBWI: $250.00
______ After 12/20/06, SCBWI member: $250.00
______ After 12/20/06, non-SCBWI member: $275.00

Conference Fees for Saturday Only (9:00 AM-4:30 PM):
______ Early Registration, SCBWI member: $140.00
______ Early registration, non-SCBWI: $160.00
______ After 12/20/08, SCBWI member: $160.00
______ After 12/20/08, non-SCBWI member: $180.00

Additional Tickets for Saturday Night Dinner:
_____ One dinner ticket is included in the registration fee of those who register for the entire weekend. Saturday Only attendees may purchase a dinner ticket for $40.00.
Guest tickets $40.00

Critique Fees ($40.00 each)

______MS X $45.00 each = $ _______

______Art/Portfolio X $45.00 = $_______

Grand Total (critique fees, registration, and additional tickets)

$_________________

Make your check payable to SCBWI-Florida. (please remember to write separate check if attending the Writers’ Intensive). Mail with registration form to:
SCBWI Florida, 12973 SW 112 Street, Miami, FL 33186.
We do not issue refunds.

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