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 staying at Beaver Meadow
Lodge, August 22-24, @ $425. This fee covers my lodging, all meals, workshops
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 Beaver Meadow is limited to 7 guests, so early registration
and payment is highly recommended.
____
I wish to be a commuter resident at the Adirondack Mountain Writers' Retreat,
August 22-24, @ $375. This fee covers my lunch and dinner, workshops and group
peer critique sessions, 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.)
DISCOUNTS:
____ I have
a money-off coupon from being an in-residence participant at a past Fiction Among
Friends retreat.
or
____ I am registering
with, ____________________________,
my friend, so that each of us may receive
a $50 retreat discount.
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:
_____
I do NOT want my name/address provided to other attendees.
_____ I understand
that I may have to share a room, but not share a bed.
_____ I will bring
my own laptop or typewriter to use.
_____ I am a smoker.
(No smoking is allowed anywhere on retreat premises or 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 at Beaver Meadow Lodge will share bedrooms and
bathrooms with other attendees where possible. Beds will be assigned on a first-paid
basis. Pictures of the rooms can be viewed at Beaver Meadow
Accommodations on this website.
2. All activities
will be conducted at Beaver Meadow Lodge (unless an optional outing is spontaneously
organized.)
3. I will submit a writing
sample of no more than 10 pages.
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:
_____ Completio and submission of Registration and Waiver.
_____ Deposit, unless paying that with PayPal
or credit card
_____ 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.)
