The Joel Fund · Creative Writing: Writing Your Book 2

Have you taken an Operation ART class before?

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Yes

No

Have you taken Writing Your Book 1?

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Yes

No

Students must have recently taken Writing Your Book with The Joel Fund or have permission from the instructor with prior writing experience in order to take this course. If you have yet to take Writing Your Book with The Joel Fund and are interested in taking this class and have experience with creative writing, please contact the Operation ART Program Coordinator, Isabella Brezenski at 919 200 0886 or isabella@thejoelfund.org.

Contact Information

Name

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First Name

Last Name

Email

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Verify Email

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Phone

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Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

If other, please provide in which county you reside.

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Emergency Contact Information

If you would like to, you may add an emergency contact to your registration. This person will be contacted by the Operation ART Program Coordinator if there is an emergency while in class.

Would you like to add an emergency contact?

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Yes

No

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone Number

Demographic Information

Please complete the demographic questions so we can understand the diversity of our class. This information is optional and does not affect your participation in the class.

What is your gender?

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Male

Female

Non-Binary

Transgender

Prefer not to state

What is your current age range?

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18 - 21

22 - 30

31 - 40

41 - 50

51 - 60

60+

Prefer not to state

What is your race / ethnicity?

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American Indian or Alaska Native

Asian or Asian American

Black or African American

Hispanic or Latinx

Native Hawaiian or Other Pacific Islander

Caucasian or White

Multiracial

Prefer not to state

Military Affiliation

What is your military connection?

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Service Member (active, reservist, National Guard)

Prior Service Member (retiree, veteran)

Military family member

Caregiver for a military connected individual

Branch of Service

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Please provide proof of service for yourself or the individual with which you are connected.

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This could be a Military ID, VA ID, or DD214.

Class Details

How did you hear about this class?

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How often do you engage with creative expression activities?

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Infrequently (less than once a month)

Sometimes (at least once a month)

Regularly (at least once a week)

Which of the following creative writing activities do you engage with?

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Poetry

Journaling

Stories (fiction and/or nonfiction)

Memoir

Drama, screen plays

Other

None

Please provide information on accommodations you may need to be successful in this class:

Media Release

Occasionally we like to post photos/videos of activities happening during TJF Operation ART Classes on social media and our website. We may photograph/video action shots of art being created. Do you agree to be photographed/videoed?

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Yes

No

Registration Payment Processing

I understand that my registration is non refundable if I am unable to attend class. Refunds will be granted if the class is canceled or if you withdraw from class up to 2 days before the start of class.

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I understand.

Amount

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$25 - Class Registration Fee