Mentorship Confirmation -

Wild Writers Mentorship Program Confirmation

Please confirm your participation in the program by completing this form by Friday, November 22, 2021 at the latest.

Name*
First Last
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Optional: Updated Writing Submission
If you have since edited the writing sample you submitted with your application, you can upload a revised sample here. Please keep in mind that the a sample of your manuscript must still be a maximum 2000 words. Files must be in .doc, .docx, or .pdf format.

Accepted file types: doc, docx, pdf, Max. file size: 300 MB.
Payment
- I am ready to process the required payment of $150.
Mentorship Fee
Price:
Card Details
Cardholder Name