Maderas Application 2021
Email address *
First Name *
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
What country are you a citizen of? *
What country are you currently residing? *
How would you define yourself? *
Required
What is your passion? *
Tell us a bit about your business, if applicable. *
What is your interest in Maderas Village Residency *
Required
Tell us about your artistic project, if any. *
How is art a catalyst for social change?  *
Do you agree for us to share your above answer with our following and tag you. This is for inspirational purposes. *
How will this residency help you achieve your artistic ambitions?  *
How can we help you achieve these ambitions?  *
What accommodations would you prefer:  *
Upon approval of your application, Momentom takes no responsibility for any theft, death or injury that may happen on residency. By clicking yes, you acknowledge all risks taken to travel and train within the residency, and responsibility for any travel insurance. *
Do you have any concerns about residency? If so, please share here.  *
How did you hear about Momentom? *
Please specify name of friend / studio / event *
Your Instagram
Your Facebook
Your Website (leave blank if n/a)
Your Whatsapp (leave blank if n/a)
Is there anything else you'd like to share with us? *
Thank you for trusting in our vision of alternative education based on art, introspection and self-expression.
Submit
Never submit passwords through Google Forms.
This form was created inside of Momentom Collective. Report Abuse