U.S. POETS IN MEXICO JANUARY 2011 APPLICATION

Application package, including signed & dated Application, 4-6 poems-no more than 6 pages total in length and a $25 check made payable to U.S. Poets in Mexico. Must be received by November 15, 2010.

Mail to: USPIM, P.O. Box 4150, Grand Central Station, NYC, NY 10163

After a review of submissions, acceptance notifications will be sent promptly every week via email on a first come/first selected basis. Tuition and fees are due upon acceptance.

Full Name  _____________________________________________Gender _____                                                                                        

Address _______________________________City_____________________State____________Zip:__________

Telephone _____________________________                                   

*E-mail (All responses will be via email) ____________________________________(We will not sell your email address to anyone)        

Date of Birth _________________  Occupation: _________________________                                                                               

Emergency Contact Name: _________________________________Tel/email: ___________________________

Have you ever visited Mexico?__________________________________________________________________

You will be required to give your passport number upon acceptance.
(We ask for your passport information in case of emergencies and in order for our Director
to vouch for the citizenship of all participants if requested at the many security checkpoints within Mexico.)

Have you participated in other Workshops? ________If yes,

Where?_____________________________________________________________________________________

Published?__________________________________________________________________________________

PLEASE CHECK:

____ I am applying to attend the Poetry Workshops 

I am a U.S. citizen ____   yes  ____ no


I intend to participate in Poetry Workshops & also:

_____ Day trip to Coba & Tulum _____Day trip to Sian Ka'an Biosphere Reserve

How did you hear about U.S. Poets in Mexico?  ___________________________________________________


U.S. Poets in Mexico January 2011 Application (Page Two)

Cancellation Policy, Terms & Conditions, Waiver

Cancellation Policy:  The balance of your tuition (minus the $200.00 non-refundable registration fee) is 50% refundable before December 15, 2009. After that date, no refunds will be made. At the sole discretion of the Director, a full refund may be returned beyond that date.  U.S. Poets in Mexico and its Director reserve the right to cancel any workshop due to unforeseen circumstances and/or substitute faculty due to the same.  In case of insufficient registration, a full refund will be returned to the applicant.  We reserve the right to modify a workshop or tour program without prior notification as may be necessary, and in such an event we will substitute comparable services of equal quality. 


Terms & Conditions:  It is the responsibility of each participant to obtain and carry a valid passport, visa(s), and any other travel documents required by applicable Mexican government regulations. It is understood that guests of participant (wives, husbands, friends or family members) must sign, and will be bound by, the same waiver contained in this Application if accompanying a participant who is attending this program.  Participant recognizes that he/she is responsible for complying with the rules and laws of the city of Merida, the State of Yucatan and Mexico.  Participant agrees to respect the rights and privacy of faculty members, fellow participants and program staff or may face removal from the program without refund.

Waiver:  Participants agree and understand that U.S. Poets in Mexico and its Director shall not be liable, directly or indirectly for any delay due to any circumstance or inconvenience related to travel. U.S. Poets in Mexico shall not be liable for any accident, including personal injury on the premises where our workshops will be conducted or at tour locations visited, or as a result of transportation to and from tour destinations and workshops, or for death, loss, or damage to a person or personal property for any participant, or guest/family member of a participant, in the U.S. Poets in Mexico workshop program.  U.S. Poets in Mexico and its Director do not assume any responsibility for losses or expenses due to civil unrest, government actions, labor disputes, theft, illness, fire, adverse weather conditions, airlines, other transportation, including tour operations, war or terrorism or any other circumstances beyond our control.

[    ] CHECK THIS BOX-I have read and agree to the Cancellation Policy, Terms & Conditions & Waiver of U.S. Poets in Mexico.


Signature _______________________________________   Date  ___________________________
                 
Printed Name ___________________________________