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-Day Saturday $95. Jan 30, Feb 20, Mar 6, Apr 10, May 22, 2010

q West Marin Water Media for Self-Expression Weekend $180. Mar 6-7, 2010

q West Marin Mixed Media Spring Intensive 1-day, $95 or 2-day, $180 or 3-day, $270. May 29, 30 & 31, 2010

q Collioure, France June 21-28, 2010 / $250 class fee deposit.

q Languedoc/Roussillon, France June 28-July 5, 2010 / $250 class fee deposit.

q Chasing Gauguin, French Polynesia July 24-31, 2010/ $250 class fee deposit.

q Umbria, Italy tba late June/early July 2011 / $500 travel deposit.

q Santa Fe, New Mexico tba September 2011 / $250 class fee deposit

q Tahiti & Huahine Islands, French Polynesia tba December 2011 / $500 travel 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) _________________