Share your information with Liz & Adam

Liz & Adam

Leaping Hound Travel

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		<field type="header" subtype="h1" label="Manuscript Academy 2026 Writing Retreat Application"/>&#13;
		<field type="header" subtype="h1" label="March 15 - 20, 2026"/>&#13;
		<field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/>&#13;
		<field type="radio-group" label="Pronouns" inline="true" name="pronouns" other="true">&#13;
			<option label="she/her" value="sheher">she/her</option>&#13;
			<option label="he/him" value="hehim">he/him</option>&#13;
			<option label="they/them" value="theythem">they/them</option>&#13;
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		<field type="text" label="Enter pronouns if not listed above:" name="enter-pronouns-if-not-listed-above" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Street Address Line 1" name="address-line-1" subtype="text" className="form-control"/>&#13;
		<field type="text" label="Street Address Line 2" name="address-line-2" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="City" name="address-city" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="State" name="address-state" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Zip" name="address-zip" subtype="text" className="form-control"/>&#13;
		<field type="text" required="true" label="Country" name="address-country" subtype="text" className="form-control"/>&#13;
		<field type="date" required="true" label="Birthday" name="birthday" className="form-control"/>&#13;
		<field type="radio-group" required="true" label="Rooming Choice" name="rooming-choice">&#13;
			<option label="Shared Room" value="shared-room">Shared Room</option>&#13;
			<option label="Single Room" value="single-room">Single Room</option>&#13;
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		<field type="text" label="Roommate Name (if sharing a room)" name="roommate-name-if-sharing-a-room" subtype="text" className="form-control"/>&#13;
		<field type="textarea" required="true" label="Tell us about your writing! What genre or age group do you write in? What is your experience? What are your overall writing goals? Etc." name="tell-us-about-your-writing-what-genre-or-age-group-do-you-write-in-what-is-your-experience-what-are-your-overall-writing-goals-etc" className="form-control"/>&#13;
		<field type="textarea" required="true" label="What do you hope to gain by participating in this retreat?" name="what-do-you-hope-to-gain-by-participating-in-this-retreat" className="form-control"/>&#13;
		<field type="textarea" label="Special needs, food allergies, or medical info we should know:" name="special-needs-food-allergies-or-medical-info-we-should-know" className="form-control"/>&#13;
		<field type="textarea" label="Anything else you want us to know?" name="anything-else-you-want-us-to-know" className="form-control"/>&#13;
		<field type="text" label="Are you a current member of Manuscript Academy? (Members will receive a $150 discount on the price of the trip.)" name="do-you-have-a-discount-code-for-money-off-your-total-trip-cost-enter-it-here" subtype="text" className="form-control"/>&#13;
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