Participant Registration Form Instructions: Fill this form out and check the appropriate boxes. When you register, please upload this form as your submission, NOT YOUR MANUSCRIPT. Please do your best to fill this out as completely as possible. Personal Information Name (last, first, middle) Address (Street) (Apt) Primary Phone Number (xxx-xxx-xxxx) (City, State) (Zip Code) Secondary Phone Number (xxx-xxx-xxxx) Email Address What is your genre? Fiction Poetry Creative Nonfiction Please let us know your sub-genre (i.e. fantasy, narrative, memoir, etc): __________________________________________ I am a: (You may check 2 boxes here. If you registered before March 23rd, you are an early registrant. If you registered after March 23rd, you are a regular registrant. If you have attended Boldface before, you will check 2 boxes.) Early-bird Registrant Regular Registrant Returning Participant Affiliate Universities or Organizations Education requirements: The Boldface Conference is currently offered to undergraduates, college graduates, and independent writers without Masters Degrees in Creative Writing. If you are currently pursuing or have received an MA, MFA, or a PhD in Creative Writing, then you may not participate in Boldface. Future MFAs/Mas: If you have been accepted to a Creative Writing program, but have not yet begun attending classes, then you may still register for the Boldface Conference. What best describes the highest level of education that you’ve completed? High School Diploma or equivalent Some college Associate’s or Professional Degree College Graduate Graduate Degree (in a field other than Creative Writing) Please indicate how many college-level workshops in creative writing you have attended. Please also indicate their genre, instructors’ names and the university at which they were given. It is not necessary to have attended any college-level workshops in order to attend Boldface. If this is true for you, please write “none” in the field below. Workshops attended: Writing Sample Please write or copy and paste a short writing sample into the following box. You can manipulate your formatting as you wish. This writing sample will only be used to match you with the workshop that will engage you the most. This sample is not the manuscript you will workshop in the conference (or at least it doesn’t have to be). Your workshop leader will be in touch with you to collect that manuscript in early May. Medical Information (This information will be kept absolutely confidential unless in the case of an emergency.) Do you have any special physical needs or medical conditions that the staff should be aware of? Yes (If yes, please indicate them: ______________________________________) No Do you have need for special equipment or space? Yes (If yes, please indicate them: ______________________________________) No Do you have any allergies? Yes (If yes, please list them: ____________________________________________) No Emergency Contact Information Name (last, first, middle) Address (Street) (Apt) Primary Phone Number (xxx-xxx-xxxx) Email Address (City, State) (Zip Code) Secondary Phone Number (xxx-xxx-xxxx) Housing Options Housing is available for an additional fee at Cullen Oaks, the newly renovated UH dorm. If you will need housing during the Boldface Conference, please check the appropriate box below. (Note: Housing does not include meals. However, the conference covers breakfast and lunch on-site Monday through Friday. The cost for housing includes lines, a pillow, and a towel exchanged. Check in date will be Sunday, May 22nd and checkout will be Saturday, May 28th before noon.) Double (shared room), $235 for the entire week I do not need housing for Boldface Individual Consultations A limited number of consultations with visiting authors are available on a first come, first serve basis. Boldface participants who sign up for individual consultations will have the opportunity to have a one-on-one consultation session with a working writer. Participants are limited to one consultation per genre, but participants can choose any genre or multiple genres for consultations. No more than 25 pages of prose, 10 pages of poetry. Each consultation is $50. Fiction Consultation Poetry Consultation Creative Nonfiction Consultation I do not require an individual consultation at this time. Payment Information Your registration will not be complete until you pay via the PayPal button on www.boldfaceconference.com/register, or send a check or money order, payable to Glass Mountain at the appropriate rate. Boldface 2016 Rates Date Students January 1, 2016 – March 22, 2016 $195 Community Members $295 March 23, 2016 – May 14, 2016 $295 $395 May 15, 2016 – May 23, 2016 $395 $495 Boldface Conference Rate: $_________________________________________________ Manuscript Consultation Total ($50 for each consultation): $____________________ Housing Total ($235 per room): $______________________________________________ Donations (we greatly appreciate it!): $_______________________________________ (Please include any additional fees, such as donations, housing, or individual consultations, in your total.) Total: $___________________ If you prefer to write a check, please make them out to Glass Mountain with “Boldface Registration” written on the memo line. Send them to: Audrey Colombe University of Houston Department of English 205 Roy Cullen Building Houston, TX 77004 Thanks for registering for Boldface! We’ll see you there! BUT! Before you submit this form, we’d love your feedback! How did you hear about us? Place a check next to the option that best applies below: Online Ad __ Website __ Social Media __ Referral __ Class Visitor __ Glass Mountain Event __ Other (please specify): _______________________ Refund policy: We understand that sometimes unexpected events happen and plans change. In the event that you are unable to attend the conference after registering, contact graduate advisor, Matthew Salesses, with a refund request. We are able to provide refunds for registration fees, housing, and consultations for requests made on or prior to May 1, 2016. After May 1, 2016, we will be unable to provide refunds. A $25 processing fee will be applied to all refunds made.