Write It Now! Winner | When Words Count Retreat

A. Fill out and submit this form (before Midnight, EST, February 15th, 2013) as the first step in claiming your prize. Late submissions will be disqualified and alternate winners will be selected.

First Name*

Last Name*

Primary Email*

Home/Cell Phone*

I am a published author currently writing on a new book.*

I am a published author, currently writing a new book.

I attest to the truthfulness and accuracy of the personal information provided above and hereby incorporate it into the Affidavit of Eligibility and Standard Release forms below.*

I attest to the truthfulness and accuracy of the personal information provided above and hereby incorporate it into the Affidavit of Eligibility and Standard Release forms below.

B. Confirm your Dates (You will find them on your Winner Announcement email.)

First Choice

Month*

Days (First "to" Last Night)*

Second Choice:

Month*

Days (First "to" Last Night)*

I would like a bonus night, so please, if possible, give preference to booking me on one of the February prize date(s) I requested.

C. Choose the number in your party and determine your Meal Deposit/Room Hold Cost

Number in your party*

D. Please read carefully and then approve each of the following documents:

I agree to terms and conditions of Affidavit of Eligibility (read)*

I agree to terms and conditions of Affidavit of Eligibility (read)

I agree to terms and conditions of Standard Release Form (read) Affidavit of Eligibility (read)*

I agree to terms and conditions of Standard Release Form (read)

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

Email: sales@whenwordscountretreat.com

Mail: Sales c/o When Words Count Retreat

1764 Marsh Brook Road

Rochester, VT 05767