WWCR First Anniversary Claims Form 2nd | When Words Count Retreat

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#1. Fill out and submit this form and then:

#2 Call us at: 443-413-1596

First Name*

Last Name*

Primary Email*

Home/Cell Phone*

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

I am a citizen of the United States or Canada, who is at least 18 years of age and am currently writing a new book.

I attest to the truthfulness and accuracy of the personal information provided herein 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 I have provided on this form and hereby incorporate it into the Affidavit of Eligibility and Standard Release forms below.

I wish to bring a guest and will pay for his/her meals

I wish to bring a guest and will pay for his/her meals. Total cost: $207.90 (tax/tip included. My deposit: $104.00)

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

Affidavit of Eligibility*

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

Standard Release Form Affidavit of Eligibility (read)*

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

Upload headshot of yourself (color digital image) for promotional purposes. *