Please print or copy the following form and mail or email to:

Carol Duchamp
Art Trek
P.O. Box 1103
Bolinas, CA 94924

cell 415-868-9558
carol@arttreks.com

Painting Class name and dates:

_______________________________________________________________________________________________________________________
q Enclosed is my class and/or travel deposit made payable to Art Trek.

q West Marin Water Media for Self-Expression 1/2-Day Sunday $40. Sept 12, 19, 26 Oct 3, 10, 17 Nov 7, 14, 21, 2010

q West Marin Water Media for Self-Expression Weekend $180. tba

q West Marin Mixed Media Fall Intensive 1-day, $95 or 2-day, $180 or 3-day, $270. Sept 4, 5 & 6, 2010

q Umbria, Italy July 27 - August 10, 2011 / $500 workshop deposit

q Tahiti & Huahine Islands, French Polynesia tba / $500 workshop deposit

q Collioure, France tba / $500 workshop deposit

q Languedoc/Roussillon, France tba / $500 workshop deposit

q Santa Fe, New Mexico tba / $250 workshop deposit

q I have enclosed an additional _______ for single accommodations.

* Please make checks payable to Art Trek.

Name (as it appears on passport)____________________________________________

Address _________________________________________________________________

City/state/zip ____________________________________________________________

Day phone _____________ Evening phone ____________ E-mail __________________

Number in party ___________        Ages _____________

Health (any special considerations, diet, etc.) _________________________________

q I would like to share a double room with _____________________________________

q I would like to share a double room; please select my roommate.  

Rooming Preference: q Male       q Female       q Smoker        q Non-smoker  

Meals:    q Regular         q Fish & Chicken         q Vegetarian         q Other _________

Art Experience:    q Beginner         qIntermediate         q Advanced

q    I will choose from the menu of accommodation options and make my own travel arrangements (if applicable).
q    I plan to fly round-trip on the group air travel itinerary (if applicable).
q    I plan to fly outbound with the group but would like to extend my stay (if applicable).
q    I will be making my own flight arrangements for this international art workshop (if applicable).

I have read and understand the information pertaining to fee, enrollment procedures, responsibilities and refunds, and I understand that all arrangements are made subject to strikes, hotel availability, devaluation/revaluation of the dollar, and other conditions beyond the control of Art Trek or their suppliers.

Signature(s) ______________________________        (Date) _________________