Name:
Hm/Work/Cell
Phones, in order of preference:
Address:
Email:
Emergency Contact:
Please
check your participant type below.
____ I wish to be resident participant,
July 30 - August 1, @ $525. This fee covers my lodging, all meals,
workshops, consultations with Irene* and group peer critique sessions.
(If planning to take advantage of a discount, please note that in
the place indicated below. Only one discount may be applied to retreats.)
Space at is limited to 7 guests, so early registration and payment
is highly recommended. All rooms should be assumed to be double occupancy.
In the event that any room may house just one, first registered will
have first dibs on the single occupancy room.
____ I wish to be a commuter resident
at the Adirondack Mountain Writers' Retreat, July 30 - August 1, @
$450. This fee covers my lunch and dinner, workshops and group peer
critique sessions, consultations with Irene,* evening activities--everything
except lodging and breakfast. (If planning to take advantage of a
discount, please note that in the place indicated below. Only one
discount may be applied to retreats.)
*If sending work in advance for Irene
to review for consultation, please mail or email no more than 10 double-spaced
pages, to be received no later than July 10th.
DISCOUNTS:
____ I have
a money-off coupon from being an in-residence or commuter participant at a past
retreat at Beaver Meadow Lodge or St. George Island.
or
____ I am registering with, ____________________________,
my friend, so that
each of us may receive a $50 retreat discount.
or
____
I have printed out a $50 discount coupon at the Adirondack Mountain Writers' Retreat
ad on www.adk360.com.
Final price
for my retreat participation: _______________ (use this figure on your check,
or on the PayPal page if you are using a credit card.)
Participant
Information (to be used for retreat planning purposes only):
Brief
Writing Bio:
Goals for retreat
(Please include any specific writing issues that you would like to address (use
back of page if additional space is needed):
Check
all that apply:
_____ It's fine with me to provide
my name/address, phone and email to other attendees during the retreat.
_____ I understand
that I may have to share a room, but not share a bed.
_____ If I wish to
use a computer, I will bring my own laptop to use.
_____ I
am a smoker but I'll restrain myself on retreat premises and in workshops.)
_____ I would like to be notified of future writing events via: __Email __USPS
List
any special needs you may have: (We regret that Beaver Meadow Lodge is not wheelchair
accessible.)
Waiver
and Assumption of Risk
I,
____________________________________________________, Customer,
of
(your address) __________________________________________________________,
State of ______________________, voluntarily
sign this waiver and assumption of risk in favor of Persis R. Granger of 11 Clarence
Russell Road, Warrensburg, NY 12885, Owner, in consideration for the opportunity
to use the facilities arranged by the owner, and/or the opportunity to receive
instruction from the owner or the owners' employees, and/or to engage in the activities
sponsored by the owners, as follows:
·
Residing in or participating in activities at sites arranged by the owners, Beaver
Meadow Lodge,
· Sharing meals, snacks and beverages prepared by the
owners or those engaged by them
· Participating in workshops, discussions
and writing exercises led by the owners or those engaged by them
· Going with or without the owners on occasional outings in the Town of
Thurman
and surrounding
area
I understand that there are
certain risks and dangers associated with the activities and use of the facilities.
I
fully assume the risks involved as acceptable to me and I agree to use my best
judgment in undertaking these activities and follow all safety instructions.
I
waive and release the owner from any claim for personal injury, property damage,
or death that may arise from my use of the facilities or from my participation
in the activities or instruction. I am a competent adult, aged 21 or older, and
I assume these risks of my own free will.
Dated
_____________________________, 20 ______
NOTES
1. Residents will share bedrooms and bathrooms with other attendees.
2. I may submit a writing sample of no more
than 10 double-spaced pages, no later than July 10.
4.
For additional lodging choices, please see Other
Lodging Options.
My submission of this form indicates that I have
read the above and fully agree to its contents.
The
above information will be used for purposes of retreat planning only and will
never be sold or given to other organizations.
Registration
Checklist:
_____ Completion and submission of Registration and Waiver.
_____ Deposit
_____ Optional
emailed writing sample, no more than 10 double-spaced pages (if no email available,
mail two hard copies, please. They will be destroyed or returned to you, as you
prefer.)
