Name

First Name

Last Name

Phone

(###)

###

####

Email (gmail is preferred)

Age

Gender

Pronouns

She/Her/Hers

He/Him/His

They/Them/Theirs

Tell us a little bit about yourself

Anything you want to share

How did you hear about Poetry for Wellness?

What interests you about Poetry for Wellness?

Describe your level of experience with writing free-verse poetry

All levels are welcome

Describe your comfort level around sharing your poetry with others

Poetry for wellness REgistration

10 spots available. Secure yours today!

Registration is open Feb 17th – March 24th 2025.

Location: 614 S Pickwick Ave, Springfield, MO

Participants must be 18+.

Nonrefundable tuition

$300 USD

Pay in full at registration