Writer's Retreat Registration 2023

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February 20–24, 2023, Rockaway Beach, Oregon

Email *

Contact Information

How can we best reach you?

What is your full name? *

How would you like us to address you?

What is your mailing address? *

What is your phone number? *

Payment Information

How and by when will you make your payment?

Please select all that apply: *

I prefer making my payment electronically (via PayPal).

I prefer mailing in a check.

I will make my payment (of $1,880) in full by 11/15/2022.

I will make my payment (of $2,100) in full by 12/15/2022.

Required

Emergency Contacts

Please include name, relation to you, and phone number.

In case of emergency, who would you like us to contact? *

In case we cannot reach them, what is another good emergency contact name and number for you? *

For Our Records

We'd love to know...

How did you hear about our retreat?

What are you most looking forward to during your stay?

Do you already know which project you'll be working on? If not, that's fine! If yes, please feel free to include a few (brief) details!

Special Considerations/Accommodations

Do you have any allergies or health conditions we should know about?

Do you have any dietary restrictions we should know about?

Do you have any physical restrictions we should know about?

And finally:

Is there anything else you would like us to know?

Would you like us to keep you in the loop regarding any future offerings? *

Yes, please!

No, thank you.

Send me a copy of my responses.

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