Student Information

Student Registration

$200.00

This price does not include lodging. Lodging must be purchased separately. After January 10th, the student registration price will increase to $250. After May 31st, student registration will increase to $300.

Student Name (printed on the name tag)

Legal Name (if different than above)

Student Email

Date of Birth

Meal Plan

The meal plan includes meals from Wednesday dinner through Sunday breakfast. (Breakfasts are continental breakfasts.)

Do you have any food allergies or dietary restrictions?

The dining hall can accommodate the following modifications: dairy/lactose-free meals, gluten-free meals, alpha-gal meals, and peanut + tree nut-free meals.

Will you be lodging on campus?

Because of venue policies, any attendee not lodging on campus must pay a $40 event fee.

What state do you live in (or country, if outside the US)?

Have you attended an in-person YWW event before? If so, what years?

How long have you been a YDubber?

What's your primary transportation plan for the retreat?

Please select your current level of education

Emergency Contact Information

Name

Relationship

Phone Number

Release Forms

Liability Release

I agree not to hold the Young Writer, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries I might incur at the retreat.

I have read and agree to the terms above.*

Media Release

I hereby give permission to appear in videos, audio recordings, films, photographs, and on websites and social media sites.

I have read and agree to the terms above.*

Do you have any allergies, chronic illness, or medical conditions? If yes, please describe.

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature

Running Total

$200.00

Coupon Code

Total

$200.00

Billing Information

Name

Credit Card

Visa
Mastercard
American Express
Discover

Address

Mobile Phone Number

Yes, it's okay to send me text messages including confirmations, changes, updates, and/or promotions. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

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