Student Information

Student Registration & Meals

$349.00

This price includes a student's event ticket, Monday dinner, and lunch and dinner from Tuesday through Thursday. This price does not include breakfast or lodging. Lodging must be purchased separately.

Student Name

Student Email

Date of Birth

Do you have any food allergies or dietary restrictions?

Will you be lodging on campus?

Because of venue policies, any attendee not lodging on campus must pay a $25 event fee.

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

$349.00

Coupon Code

Total

$349.00

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.

Event Registration Software by RegFox