Enrollment Form
(Please print, complete and mail this form.)
To confirm a reservation it is necessary that this form is filled in and signed, then mailed to us with the necessary payment. Enrollment requests are processed on a first-received basis. Due to enrollment limitations we may not be able accept all requests for enrollment. In this case we may offer you alternate dates which you may elect to accept or decline within seven days. Enrollment and reservation forms may not be accepted less than 60 days prior to workshop start dates without prior agreement.
PARTICIPANT INFORMATION
(List all participants and non-participants separately and include with this form)
Contact Name________________________________________________
Address_____________________________________________________
City__________________________ State__________ Zip Code________
Country______________________________________________________
Telephone-Day_______________ Telephone-Evening_________________
Email__________________________ Fax__________________________
Emergency Contact phone number: ____________________________
Special or dietary needs:_____________________________
*I have read and agree to the Enrollment Terms and Conditions (see below).
Signature (required) X _________________________________________________
BOOKING PERIOD
__From participant check-in in Positano Saturday October 13, 2012 to departure in Positano Saturday October 20, 2012.
Total Due: $_______________ (Payment due in full by July 13, 2012)
US$250.00 deposit per person due with enrollment form.
Total Deposit Due: $_________
Preferred Payment Method (See Enrollment Terms and Conditions below )
Checks accepted only. Make checks payable to: "Patrick J. Mahoney TA"
Authorized Signature________________________________________
Mail completed form and deposit/payment to:
"Plein Air Positano & the Amalfi Coast" 2012
Patrick Mahoney/TA
367 West Broadway
Gardner, MA 01440
USA
All enrolled participants will receive written confirmation and further workshop information. This workshop is offered based on a minimum number of 8 Workshop Participants.
We look forward to
"Plein Air Positano & the Amalfi Coast"
with you!
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