#1. Complete and submit this form before the prize-claim deadline.
#2 Include your certificate discount code in the space provided (Late submissions will be disqualified.)

Choose your Alternate May Prize Date(s) below, entitling you to a FREE Room for a 3-Day/Two-Night Stay in May, should you later qualify for a 3rd-Place prize.)

First Choice
Second Choice:
Please read carefully and then approve each of the following documents:

Also, for your convenience, you may download the forms, print, complete,
sign and return them by mail (hard copy) or email (scan).


Mail:  Sales c/o When Words Count Retreat

           1764 Marsh Brook Road

           Rochester, VT 05767

1Limit: one certificate per customer, per room. Non-transferrable. May not be combined with any other offer. Cash surrender value: 1/10,000 of a cent. Good only for WWC Retreat Stays in June, 2013. Valid through 11:59 p.m. EST Monday, March 18, 2013 and only if activated by completing prize-claim process.