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.

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. Do you have any special dietary needs? (if so what are they? e.g. vegetarian)

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

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No

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if yes, please name the medication and provide details of dosage and administration (we may need to chat with you about keeping it locked up while you are here, for the safety of others).

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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

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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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Poatina chalet (very special rates): (03)63978290 poatina_chalet@fusion.org.au

Chalet motel room $50/room/night

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House - for a family ($160 for the retreat)

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Chalet backpackers ($10/person/night)

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Billet options: $20 donation for 5 nights

Billet (I will arrange my own)

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Billet (I would like help to approach someone in the village on my behalf)

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