FATA Registration Form 2012

Fill in the following 5 sections and click submit button at the end.

We will be in contact with you to confirm your registration.


Title (*)

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First Name (*)

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Surname (*)

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Birthdate (*)

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Email (*)

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Age (*)

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Address (*)

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Address 2

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Town (*)

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State (*)

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Postcode (*)

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Phone Home (*)

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Phone Work

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Mobile

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Travel to Poatina details

I will be travelling to Poatina by (*)

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I require to be picked up from Launceston Airport upon arrival

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Please ensure your arrival time in Launceston is before 2.30pm on Sun 8th Jan 2012


If you are travelling by plane and do not yet know your flight details that’s ok. Please indicate above that you will be flying, and leave the flight details blank. You can forward flight details once we’ve emailed you with receipt of your registration and payment details.

Airline

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Flight number

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Arival date


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Arival time

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I am travelling TO Poatina with these people (names please):

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Travel home details

I will be travelling from Poatina by:

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I require transport to Launceston Airport for my departure

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Airport departure time must be after 12:00pm on Sun 15th Jan 2012

Airline

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Flight Number

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Date


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Departure time

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I am travelling FROM Poatina with these people (names please):

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We would love to gather a bit more information from you, if you could take a few more moments to fill in the following it would be most helpful, thanks!

My special dietary needs are

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I heard about FATA by

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What do you hope to go away with at the end of your time in Poatina? (*)

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Electives to choose from are: Painting and Drawing, Hot Glass, Dance, Drama, Creative Writing - Poetry, Creative Writing - Fiction, Ceramics, Photography, Music, Printmaking, Clowning & Mime, Stagecraft/Visual Theatre.
Please note, sometimes you may not get your first choice. Eg. if an electives does not have sufficient numbers or has already been filled - but we will contact you prior to the Summer School if this is the case.

Electives 1st choice (*)

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Electives 2nd choice (*)

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Electives 3rd choice (*)

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Cost includes Food, accommodation (shared backpacker style), materials, and tuition during the whole 7 days course.
If you choose to stay longer before or after the 9th - 16th January negotiation needs to be made. Accommodation will be tight, as there are a number of courses happening in the village the same week, so prompt registration will ensure you have a place.


Full payment is required to complete your registration.


I agree to work within the norms and boundaries of Poatina Village and the Summer School. (For more information, please contact us via the “Contact Us” page). I agree that a photo or video of myself, and any accompanying persons, or of my artwork taken whilst in Poatina may be used for promotional purposes by Fusion Australia.

I Agree

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Enter the text exactly as it appears below.
Enter the text exactly as it appears below.

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Registration Fees (*)





Please choose your registration fee type. Please choose your fee type above.
Concession Fee is for Unsalaried or Student Registrants.



Hot Glass Elective Materials Fee

Invalid Input If you have chosen to do the Hot Glass Elective, please tick this materials fee to add to your total.

Accomodation Upgrade

Invalid Input Course fees include shared budget accommodation backpacker style, with shared bathrooms. If you would like to upgrade to a motel room with en-suite, please select your preferred option from the drop down box above.
We have double, twin, and double + single motel rooms available and sharing with a friend(s) is encouraged to make best use of the limited space available.
Motel cost is an additional $30 per person per night (sharing with at least one other) or $50 unshared (depending on availability)

Have you upgraded to a motel room? Who would you like to share your motel room with?

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Family Accomodation:

Invalid Input There are a limited number of houses and mountain cottages available for family groups. Please indicate above if you would like someone to contact you about the possibility of renting one of these.

Total Fees
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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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