* 1. Please write your full name:

* 2. Please provide your email address

* 3. From where are you traveling?

* 4. What nights do you need housing for PPW 2014?

* 5. Do you have any pet allergies?

* 6. Please provide any additional information in the box below:

* 7. Release: Participant agrees to release, indemnify, hold harmless and defend the Academy and its members, trustees, directors, officers, employees, contractors, agents, affiliates, and successors and assigns (collectively “Releasees”) from and against any claim which Participant, his/her legal guardian(s), or any other person, may have for any losses, damages, or injuries arising out of or in connection with Participant's participation in the housing accomodations. The Academy shall also not be responsible to Participant, Guardian, and/or any other person for illness, injury or damage to or loss of property due to Participant's own acts or omissions.