APPLICATION FORM

Breeze Hill Writing Retreat

Please complete this form and return it to

Breeze Hill Writing Retreat

P.O. Box 1106

Northport, AL 35476

Your name:

Your address:

Your e-mail address:

You must include with this application a check for $40.00 made out to “Breeze Hill Writing Retreat.” If you are not chosen for the retreat, your check will be returned to you. If you are accepted for the retreat, your check will become your registration fee. Once you are accepted, the $40.00 is NOT REFUNDABLE.

Please check which of the two retreats you are applying for. If you would like to attend both retreats, indicate your order of preference by marking your first and second choices as #1 and #2. (Because of the limited number of applicants who may be accepted, it is unlikely anyone will be accepted for both retreats.)

___ “Writing and Publishing Your First Novel.” (Feb. 4, 2012)

___ “Writing and Publishing Nonfiction Books” (March 3, 2012)

Provide a brief summary of your writing and publishing experiences:

Provide a brief statement of why you wish to attend the retreat you have selected: