APPLICATION FORM FOR INTENSIVE WORKSHOP (New Student)

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 Singing (Graeme Du Fresne)
Workshop 2 Directing (Janice Dunn)
Workshop 3 Acting (Freddie Machin)
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 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
  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).
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)
  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 two equals? (this is just to check that you really are human)
**We cannot guarantee provision for all special needs, but will do our best