Adirondack Mountain Writers' Retreat
Creative Writing Weekend Workshop
(Fiction/Memoir/Personal Essay)

From noon, Friday, July 30 through noon, August 1, 2010
A Three-Day Workshop taught by Irene Sherlock

This event has in past years been funded in part by Poets & Writers, Inc. with public funds from
The New York Sate Council on the Arts, a state agency


Only six openings remain.
Updated 6-19-10

REGISTRATION FORM

Print and mail the ugly registration form below to:
Perky Granger, 11 Clarence Russell Road, Warrensburg, NY 12885
OR
Request a tidy emailed Word Document registration form.
The emailed form may be completed on your computer and sent back as an email attachment.

$100 minimum payment is due upon registration in order to hold your spot. Slots will be assigned in the order in which deposits are received.

IN-RESIDENCE RATE: $525, LESS ANY DISCOUNT THAT MAY APPLY.
COMMUTER RATE: $450, LESS ANY DISCOUNT THAT MAY APPLY
.

(Discounts described on registration form.)

 
Pay by check, or
click here for secure online payment.
See payment details at bottom of this form.

(Revised May 9, 2010)


REGISTRATION FORM

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 Thu
rman 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.)

RETREAT PAYMENT

Retreat and workshop space is limited and will be reserved on a first paid, first served basis.
  • Please send a $100 deposit with your registration form.
  • Make check or money order (preferred) payable to Persis R. Granger, or pay with credit card or PayPal on website.
  • Balance Due:July 15. (May be paid in lump sum or installments.)
Please make checks payable to Persis Granger.

Perky Granger
11 Clarence Russell Road

Warrensburg, NY 12885
RETREAT CANCELLATION
  • There is no penalty for cancellations made in writing before July 1st.
  • Those canceling in writing between July 1st and July 15th will be charged a $100 processing fee.
  • There will be no refunds for cancellations made after July 15th unless the vacancy created by your cancellation is filled, in which case you will forfeit $100.
  • Late registrations will be accepted after July 15th only if space is available.

    Cancellation will be presumed if payment in full is not received by July 15, 2010.


The retreat site has limited space. Sleeping space is limited to 8. There will be only 10 participants in all. We recommend you apply early.

ONE MORE THING: Would you please take a moment to let me know how you learned about The Adirondack Mountain Writers' Retreat?

Adirondack Area - Adirondack Center for Writing - Adirondack Mountain Writers' Retreat - -About Irene Sherlock
-
Contact Us- -The St. George Island Writers' Retreat
Other Lodging Options -Persis Granger Home - Payment with Credit Card on PayPal