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The University of Tennessee at Martin

The University of Tennessee - Martin

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Extended Campus & Online Studies
110 Gooch Hall
University of TN at Martin
Martin, TN 38238
(731) 881-7080
Toll Free: 1-800-482-5199
Interim Director: Tommy Cates

ecos@utm.edu

Youth Writers' Clubhouse

Registration Form
Youth Writers' Clubhouse
Date:

October 24at UT Martin, Martin, TN

October 31 at UT Martin Ripley Center, Ripley, TN

December 5 at UT Martin Jackson Center, Jackson, TN

January 23 at UT Martin, Martin, TN

January 23 at UT Martin Ripley Center, Ripley, TN

February 13 at UT Martin Jackson Center, Jackson, TN

Registration fee:  $30 per session or 2 for $50
   
Student Name:
School Currently Attending:
Date of Birth:
Current Grade:
Street Address:
City:
State:
ZIP:
Email:
Parent/Guardian Name:
Parent/Guardian Email:
Home Telephone:
Work Telephone:
Cell Phone:
Emergency Contact Name:
Emergency Contact Number:
   
Payment information. Please check one.
Cash. Please bring exact payment to 110 Gooch Hall.
Check. Make check payable to UT Martin and mail to:
ECOS
110 Gooch Hall
Martin, TN 38238.
Your check will serve as your receipt.
Credit/Debit Card (VISA, MasterCard, Discover): Contact ECOS at 731-881-7082 or 731-881-7081.