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 Bolinas, California Water Media for Self-Expression 1-Day Sat $95. Jan 28, Feb 25, Mar 24

q Strasbourg, France Watercolor and Wine. June 19- 29 / $1200 workshop deposit

q Gubbio, Italy Poetics of Water Media Painting. July 3-14 / $1200 workshop deposit

q Tahiti & Huahine Islands, French Polynesia Poetice of Water Media Painting. Dec 20-30 / $1200 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

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) _________________