Kindling Words East Registration "*" indicates required fields 1Register2Upload Slide Images3Payment Personal DetailsThis information will be included in the bio book so you are able to communicate with your new and old friends after the weekend. The Bio Book is printed and shared as a PDF. It is against Kindling Words policy for anyone to use this info for anything other than personal connections. It is never allowed to be shared beyond our group.Name* First Last Name Pronunciation*Please write out your name phonetically Preferred Pronouns* she/her he/him they/them additional/other pronouns Additional/other pronouns Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Phone*Website Strand*Check all that apply Author Illustrator Editor Types of books you create(or would like to!)Please check all that apply for your writing, illustrating or editing work. Picture Books Early Readers Chapter Books Middle Grade Young Adult Adult Graphic Novels Novelty books Fiction Non-Fiction Will this be your first Kindling Words East?* Yes! It's my first time attending No - I've attended before Bio*Short bio - 100 words or less.Headshot for Bio*The photo is so that we can match names to faces. Please submit a recent photo that is recognizably YOU (use a photo of your face with no pets, kids, or props getting in the way). Headshots for the Bio Book must be 300 DPI and at least 1.5 inches wide. Thanks!Accepted file types: jpg, jpeg, png, Max. file size: 4 MB.Title of one of your books to be featured* Publisher & year of publication* About the food*We would like a rough count for the vegetarian main dish. I will eat only vegetarian meals I will likely choose from both vegetarian and meat / fish choices I will not be eating the vegetarian main dish Any food restrictions or allergies?We will share this information with the conference center, but please be sure to confirm with hotel staff with upon arrival. Slide ImagesPlease upload additional photos as below for the intro slideshow. The images should be no less than 75 DPI, but a greater DPI would be better. We want to make the clearest presentation of your life and work.Photo 1 - Image of your book*This should be one image with the cover of one or more of your books. (If you are a debut creator and you don't yet have a cover image, you may submit an image of title, publisher & pub year of a book under contract). Please title the file "YOURFULLNAME_book"Accepted file types: jpeg, jpg, png, Max. file size: 4 MB.Photo 2 - Your family/loved ones*Human or otherwise! Please title the file "YOURFULLNAME_family"Accepted file types: jpeg, jpg, png, Max. file size: 4 MB.Photo 3 - Fun photo of you*An image of you doing something fun! Please name the file "YOURFULLNAME_fun"Accepted file types: jpeg, jpg, png, Max. file size: 4 MB. PaymentKindling Words East Cost*$275 tuition + $428 Southbridge fee for meals & meeting rooms = $703 total (refundable through December 1st, 2022). Please book your hotel rooms directly through Southbridge. Price: Scholarship Fund DonationIn this business, fortunes fluctuate. If you are having a stronger year, please consider making a donation to the scholarship fund so that another person in a different stage might be able to attend. None for nowTwenty-fiveFiftyHundredActivation CodePlease enter your activation code if you received one. It's not required - if you don't have one, just hit submit below. TotalThis is the amount that will be sent to Paypal when you click the "submit" button below. If you prefer to pay by check, or if you would like to request an installment plan, please contact us at kwe@kindlingwords.org before submitting this form. CommentsThis field is for validation purposes and should be left unchanged.
