Woodstock Mayapple
Writers' Retreat

Roethke House interior

Application Form for 2012

Please complete and submit the form below as early as possible to help us assess interest and complete our planning. Fill in requested content in each box. When you click "Submit" an email message will be sent to the program coordinator. We are having problems with this form. Please print out and mail, or send us an email containing the requested information at kerman@svsu.edu

Name Street address
Home Phone number City, state, zip code
Cell Phone number Main genre(s) you work in
Email address Preferred workshop genre
Will you need housing?

Mixed-genre workshop OK?

Will you drive or fly? If flying, into which airport?

Are you listed in Poets & Writers Directory?

Are you an Associated Writers and Writing Programs (AWP) member?
If you teach creative writing at an accredited college/university, which one?
If you have an MA or MFA in Creative Writing, which college/university?
If you would like to attend Woodstock Mayapple Writers' Retreat but do not meet the criteria indicated above, please list several major publications in this box, including publisher and date, and send samples of your work to kerman@svsu.edu. (Maximum 5 poems or one short prose work, embedded in your email message or attached as .RTF file.) Please indicate "Rustbelt Roethke samples" in the SUBJECT line of the message.


Fees: $450 including housing; $250 commuter; includes picnic and festive meal. Early registration discount: $50 with housing, $25 commuter, if paid in full by May 15, 2012.

Please send an indication of interest as soon as possible. Deposit is due no later than May 1, 2012: $100 for those requiring housing, $50 for commuters. The balance is due by July 1, 2011. Refunds (minus a $25 cancellation fee) available only if requests are received in writing or by email by July 15, 2012. We can't hold a space for you until we have received your deposit. Thanks! Early enrollment discount:!

Checks should be made out to Mayapple Press and sent to Judith Kerman, 362 Chestnut Hill Road, Woodstock, NY 12498. Be sure to note Mayapple Woodstock Writers Retreat in the Memo section of your check. Please do not send checks to Judith Kerman personally.

Please let us know if you need any special accommodation when you send your check.

SVSU will provide reasonable accommodations for those persons with disabilities. Individuals who wish accommodations should contact the University Conference and Events Center at 989-964-4348 at least three days prior to the event. SVSU does not discriminate based on race, religion, color, gender, sexual orientation, national origin, age, physical impairment, disability or veteran status in the provision of education, employment and other services.