CNIB - Creative Writing Registration Form

Thank you for your interest in CNIB Creative Writing Program!

In order to complete your registration, we need to get to know you a bit better. Please be assured all information gathered is private and confidential.

* Indicates a required field.

Contact Information

First Name

Last Name

Preferred Title

Preferred Personal Pronoun

Primary Phone (###-###-####)

Phone Type

HomeMobileWorkOther

Address

City

Province

What CNIB Region in Ontario would you like to be referred to?

Postal Code

How did you hear about CNIB?

Area of Interest

Please choose your area of interest:

I am thinking about submitting a story, essay or poem for this project before October 15, 2020 – please email me a submission form

I am interested in participating in a virtual writing circle (to share constructive feedback with other participating writers).

I am interested in attending a presentation to learn more about what Arts Council funding may be available to me as a writer.

I am interested in attending a virtual presentation about publishing options in Canada.

I am interested in attending a virtual discussion about self-publishing options.

Please note:
You will be contacted by email with details once the workshops have been scheduled. The workshops will take place via the Zoom platform.

Declaration and Submission

Please read the following declarations carefully prior to checking the box stating that you agree to the outlined declarations and submitting your application.

I understand that the Creative Writing Project campaign is open to Canadians living with sight loss and I identify as being part of that community.
I declare all the information provided on this form and in any other accompanying documents is complete and true in every respect.
I understand failure to completely and truthfully answer the questions asked of me, when discovered, will constitute grounds for immediate rejection of my application.
I understand that all personal information which become part of this application will be regarded as confidential pursuant to the Freedom of Information and Protection of Privacy Act.

I have read, understood and agree to the above declarations.

Yes

For assistance please contact us at our Contact Centre: 1-800-563-2642.