|
Personal Details |
| |
|
|
Name (First / Last )
|
/
|
|
Address
|
|
|
City
|
|
|
Post Code
|
|
|
Country
|
|
|
Email address
|
|
|
Phone number(s)
|
Home
Mobile
|
|
Date of Birth
|
|
|
Gender
|
|
|
Nationality
|
|
|
Heard about LEATSS from
|
|
|
Workshop Preferences |
|
|
Workshop 1 The Physical Text (Mike McCormack) |
|
|
Workshop 2 Radio Drama (Mike McCormack) |
|
|
Workshop 3 ( ) |
|
Accommodation |
|
|
I would like a single room at a supplement of €25.00 per workshop (subject to availability) |
|
|
I would like to share a room with
|
|
|
I would like to enroll as a day student (no accommodation) |
| |
|
I would like a room with private bathroom at a supplement of €
20.00
40.00 per workshop (Please note: all private bathrooms are now allocated. Selecting this will add you to the waiting list). |
| |
|
I would like to stay extra nights at a supplement of €
30.00
35.00 per night
45.00 per night
35.00 per night
|
| |
|
Before my course
|
| |
|
After my course
|
|
|
Dietary Requirements and Special Needs |
|
|
I would like to take the meat option for meals (mostly meat, some fish and vegetarian) |
|
|
I would like to take the fish option for meals (mostly fish, some vegetarian) |
|
|
I would like a diet with neither fish nor meat |
|
|
Please indicate any other special needs (vegetarian, vegan, gluten free diet, mobility etc.)**
|
|
Project Preferences |
|
Data Privacy |
| |
|
I consent to LEATSS a.s.b.l. storing my personal data electronically according to their privacy policy |
|
|
I consent to photographs taken during LEATSS events that contain images of me being stored electronically and used in publicity material. |
| |
|
| three plus one equals? |
|
(this is just to check that you really are human) |
|
|
**We cannot guarantee provision for all special needs, but will do our best |