Artists Retreat Registration form.

If you fill in the following pages and submit the form, we will get back to you with more details soon.


Please submit one form per person.

First Name (*)

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Surname (*)

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Address (*)

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Town/Suburb (*)

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State (*)

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Postcode (*)

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Phone Home (*)

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Mobile (*)

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Email (*)

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1. What has drawn you to participate in the artist retreat for 2012?

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2. Which area / discipline would you like to be working in? (painting, music, dance, puppets, etc) (*)

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3. What equipment / materials / instruments do you need to bring to be able to work in the area?

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4. Are there particular items you would like us to help source or other challenges you need help with? (No promises but we’ll do our best!)

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5. Are there specific ideas / projects / things that you would like to work on during the retreat?

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6. Are you open to others joining in with your idea / project?

a. Yes (details can be discussed on “artists’ retreat, poatina” facebook site)

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b. No, I’d prefer to work alone or with specific people I invite

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c. I don’t have my own idea / project and would like to join in with others.

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7. Are you vegeterian, or are there any foods you are allergic or intolerant to? (*)

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8. Are you taking any regular or currently prescribed medication?

No

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Yes

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If yes, please give details of the medication and dosage

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Travel to and from Poatina if applicable (may be forwarded later)

Arrival date


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Arrival time

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Travel by car/plane (*)

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Flight details/Airline and flight number. It is important that you enter this detail for us, as we use this information to work out when and where to pick you up from the airport. Thanks! If you are not sure of flight details yet, just write WILL RING WHEN I KNOW, and ring us ASAP you know the details. Please also ring the day before you leave to confirm what time you will be picked up.

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I need transport from the airport please

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Departure date


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Departure time

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Depart by car/plane

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Departure Flight details/Airline and flight number

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I need transport to the airport please (*)

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Artists' Retreat Fee (*)

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Plus Accomodation Costs - please select (all options are for 5 nights) (*)

please select your accomodation option
Total Fees + Accomodation
0.00 AUD

If you have chosen the Chalet shared room option, please provide the name of the spouse or friend you would like to share with.

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If you have chosen the Billet option, please select billet arrangement.



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When you click SUBMIT you will be taken to Paypal's secure payment page. You can then pay using your Paypal account OR choose to pay by credit card without a Paypal account.


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