Academic Writing Retreat

Registrant Information

First Name

Last Name

Affiliation

Email Address

Phone Number

Retreat Details

Food Allergies or Dietary Restrictions

What is the project you plan to work on during the retreat?

Which parts of the retreat most interest you?

Time and space to write

Skill Session--Planning and Executing Writing Projects

Skill Session--Journal Selection and Submission Preparation

Skill Session--Strategies for Sustaining Writing Momentum

Check Ins and Goal Setting

Payment Information

Registration Fee

Regular Registration - $150.00

Graduate Students and Independent Scholars - $120.00

Total

[not yet calculated]

Payment Method

Credit Card

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Last Name on Credit Card

Billing Address

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Credit Card Information

Credit Card Number

Expiration

01 - January 02 - February 03 - March 04 - April 05 - May 06 - June 07 - July 08 - August 09 - September 10 - October 11 - November 12 - December 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041

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3 or 4 digit code on back of card

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