Kindling Words – KW-West Register

KWW at Whidbey Island Registration - Multi-Page

Personal Details
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Mobile Phone*
Email*
Website
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

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Strand*
Check all that apply
- Author
- Illustrator
- Editor
Bio*
Short bio - 100 words or less.
Photo*
Head shot (Clear, recognizable photo. No full body or group shots, please). Should be 300 dpi resolution at 1" wide, or a minimum of 480 pixels wide if uploading a web-based image.
Accepted file types: jpg, jpeg, png.
Most recent/Best-known book title*
Publisher*
Date book was published*
Date Format: MM slash DD slash YYYY
Slide Images
Please upload 6-8 photos for the slideshow. These will be shown in order from Slide 1 - Slide 2 - etc. Pictures for the Intro Slideshow 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.
Slide 1
Accepted file types: jpeg, jpg, png.
Slide 2
Accepted file types: jpeg, jpg, png.
Slide 3
Accepted file types: jpeg, jpg, png.
Slide 4
Accepted file types: jpeg, jpg, png.
Slide 5
Accepted file types: jpeg, jpg, png.
Slide 6
Accepted file types: jpeg, jpg, png.
Slide 7
Accepted file types: jpeg, jpg, png.
Slide 8
Accepted file types: jpeg, jpg, png.

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Accommodations*
What is your rooming preference? Putting together the housing list at Whidbey will be a bit of a moving puzzle until everyone signs up.
- I require a single room
- I would prefer a single room if possible
- I would prefer to share a room
- I would be glad to share a room if necessary

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Tuition Payment
Waiver of Liability*
I hereby freely and voluntarily, without duress, execute this Release under the following terms:
1. General Waiver and Release. I release and forever discharge and hold harmless Kindling Words (KW) and its affiliated organizations, directors, officers, employees, and agents, and their successors and assigns, from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my participating in the Kindling Words Scotland program and related activities whether such liability, claims, or demands results from travel, from disease, consumption of food, or from civil unrest or otherwise.I understand and acknowledge that this Release discharges KW from any liability or claim against it with respect to any bodily injury, personal injury, illness, death, monetary loss or property damage that may result from my participation in the program. I understand that KW assumes no responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance, in the event of injury, illness, death, accident, monetary loss or property damage.
2. Medical Treatment. I hereby release and forever discharge KW from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered to me or to my dependents/companions in connection with an emergency or health problem during my participation in the program.
3. Assumption of Risk. I understand that my participation in the KW program may include activities and circumstances that may be hazardous to me, including, but not limited to, international travel, and local transportation in the country of my travels.
4. I hereby expressly and specifically assume the risk of injury or harm in these circumstances and release KW from all liability for injury, illness, death, monetary loss or property damage resulting from such circumstances during my participation with the KW program, whether suffered by me personally or by any of my accompanying dependents or companions.
5. Other. I agree that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable. I understand that any dispute concerning this Release or any aspect of my participation in the KW program shall be brought in the state or federal courts of Vermont.
- I agree to the Waiver of Liability
By checking this box, I hereby certify that I have read and agree to the waiver of liability terms set forth in this document, and that all the information I have provided is accurate and complete.
Activation Code
Please enter your activation code if you received one. You don't need a code unless you've been given one. If you don't have one, just hit submit.
Tuition Deposit*
($430 tuition + PayPal fee)
Price: $430.00
PayPal Fee
Price: $0.00
Total
$0.00
Comments
This field is for validation purposes and should be left unchanged.

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KW-West Register

Kindling Words West Registration

KWW at Whidbey Island Registration - Multi-Page

Personal Details

Slide Images

Tuition Payment