The Artist Retreat commences on Tuesday evening from 7.00pm and concludes Sunday after lunch.

As there is a limit of nine places on this Artist Retreat, a selection process may be necessary if applications
outnumber places. To help your application please fill in this form as fully as you can.

NAME:_____________________________________ OCCUPATION: ___________________________

ADDRESS:___________________________________________________________________________

PHONE (home) _______________________ PHONE (mobile) _________________________________

E-MAIL_________________________________________________ AGE : ___________________

DETAILS OF ART EXPERIENCE: ________________________________________________________

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WHAT DO YOU HOPE TO GET OUT OF THE RETREAT? _____________________________________

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Room preference. Please tick: Share twin ( $825 per person ) ______ , Single room ( $950 ) ______

If sharing, is there a person you want to share with? ...Yes / No.....Name of person ______________________

Are you a vegetarian? _________________

Please enclose $100 deposit. Full fee is payable before 7 February. FEE ENCLOSED: $_____________

Cheque to "Wendy Leach" and post to: Wendy Leach, 25 Benbow Street, St Heliers, Auckland. Phone 09 5758950