Hearts in the Sand Entry Form

Please fill out the Hearts in the Sand Conference entry form below in its entirety. Upon completion and clicking on ‘SUBMIT’ you will be redirected to our PayPal page to process your payment.

Name: *

Address: *

E-mail: *

Phone: *

RWA Membership# (if applicable):

First Line on Badge - Preferred name for name badge: *
Second Line on Badge - (i.e. pen name, chapter, home town): *

Conference Fee (Select One): *

Pitching Opportunities:
First pitch is included with in your registration fee. Second pitch is $15. Please select your 1st and 2nd choice if interested.

Deb Werksman, Editorial Director of Sourcebook:

Tina Wainscott, Agent with the Seymour Agency:

Add 2nd Pitch:

Add On Raffle:
Win a 2-Night Stay! At the Embassy Suites by Hilton, Estero/Fort Myers (not applicable during the 2018 Hearts in the Sand dates). Tickets will also be available to buy at the conference.

Single Raffle Tickets:

Multiple Raffle Tickets:

Dietary Restrictions:

PayPal Account E-mail (if different than email entered above):

Word Verification: