North Carolina Writers' Network

Squire Summer Writing Residency
Payment of Balance Due

Please provide the same contact information that you provided on your initial registration form. If you pledged a donation on your initial registration form, please include your donation with the payment balance.

Thank you for your support of the NC Writers' Network.

This form requires you to pay by Visa, MasterCard, Discover, or Diners' Club. To pay by check, print and complete the form, and then mail it with your check to NC Writers' Network, Squire Summer Writing Residency, PO Box 21591, Winston-Salem, NC 27120.

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First Name*
Last Name*


Phone (day)*
Email address*
Payment balance* $