Complete this form to register for the Corks + Melanin: Salamander Experience

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
Name*
As it appears on your passport
Address*
We need to know how young you are 🙂
MM slash DD slash YYYY
Select your current or desired club affiliation.
Desired Occupancy Type*
If you need a roommate, then please let us know and we'll match you with someone!
Desired Room*
List your roommate's full name. If your occupancy is single, please enter N/A. If you need a roommate, please enter NEED.
Enter your 3-letter departure airport code. If you are driving to the resort, please enter N/A.
Roundtrip transfers will be provided from DCA and IAD. If you are driving to the resort, please enter N/A.
Flight Booking Preference*
Please enter your departure airport in the comments section if you would like us to book your flight.
T-Shirt Size*
Corks + Melanin t-shirts will be distributed to new members upon arrival. T-shirts must be worn at Saturday's Bottled Poetry Tasting. Existing members will receive a welcome back gift.
Photo and Video Consent*
I hereby consent to the participation in interviews, and the taking of photographs, movies, or videos by Corks + Melanin and Blue Dynasty Entertainment and Travel agents and affiliates. I also grant to Corks + Melanin and Blue Dynasty Entertainment and Travel, the right to edit, use, and reuse said products for marketing purposes including use in print, on the internet, and all other forms of media. I also hereby release Corks + Melanin and Blue Dynasty Entertainment and Travel and its agents and affiliates from all claims, demands, and liabilities whatsoever in connection with the above.
Travel Protection Plan*
We strongly recommend that you purchase a travel protection plan to cover cancellation and change fees. A Travel Protection Plan can protect you from possible loss due to unexpected trip cancellation, trip interruption, baggage loss and medical emergencies. Your travel includes some non-refundable fees, namely, the cost of travel protection. For Travel Protection Plans purchased separately from your vacation, the "cancel-for-any-reason" option must be purchased within 14 days of your initial deposit. Also, for the plan to cover "pre-existing medical conditions", you must purchase a plan within 14 days of your initial deposit. Other plans can be purchased up to 72 hours before departure. Airfare booked outside of your vacation package is not covered by these travel protection options - unless the flight cost is included in the total trip cost while quoting insurance.
Share any additional relevant information.
I have been advised that there are cancellation penalties and non-refundable costs and fees associated with this trip.
Today's date
MM slash DD slash YYYY