DIVE INTO LIFE 2019-BOOKING FORM
Name and Age/DOB
Name
Age/DOB
Email
Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Telephone:
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Previous art experience:
How do you feel about your art right now?
What do you hope to gain from this experience?
How will you travel to France?
If driving, can you offer car share?
yes
no
N/A
If Yes, where from?
Any special diets?
Please select which room option you are booking:
EARLY BIRD Shared non-ensuite £800
EARLY BIRD Shared ensuite £900
Shared non-ensuite (booked after June 1st) £850
Shared ensuite (booked after June 1st) £950
Single Room £1250
DEPOSIT
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next
( X )
NON REFUNDABLE (pay at the end)
£150.00
£
150.00
If sharing a room, who would you be sharing with? If unknown please say so.
Do you need to set up a Standing Order?
Where did you hear about this retreat?
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