Application Form - La MaMa Umbria International Playwright Retreat 2017
Still Accepting Applications!
Name: *
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Company/Organization:
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City: *
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State: *
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Zip: *
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Country: *
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Email: *
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Website:
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Telephone Number (1): *
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Telephone Number (2):
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Date of Birth: *
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Sex: *
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I am applying for the La MaMa Umbria Playwright Retreat - August 18-28, 2017. *
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Special Dietary Requirements:
(please specify)
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Please answer the following questions, limiting your responses to the length of one double-spaced page each.
Why is the Playwright Retreat appropriate for you at this time? *
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How might this experience help you as an artist? *
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Do you hope to work on an existing script or begin something new (or both?) *
Please briefly describe the existing work, if there is one.
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What do you hope to achieve during the retreat to consider it successful? *
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Payment Options
You may put down a deposit to hold your place ($500) or pay the fee in full. The fee rates are:

Playwright Retreat Deposit Fee: $500
Playwright Retreat Full Payment Fee: $2,400

You may pay by credit card by following the links below:

Umbria Playwright Retreat (Deposit)
https://web.ovationtix.com/trs/store/42/pr/58765

Umbria Playwright Retreat (Full Payment)
https://web.ovationtix.com/trs/store/42/pr/58766

- OR -

You may send a check in US$ made payable to La MaMa ETC addressed to La MaMa ETC Symposium, 74A East Fourth Street, New York, NY 10003.

- OR -

You may pay by Bank Transfer by calling +1-212-254-6468.

- OR -

You may pay in Euro through Bank Transfer by contacting info@offucina.com or calling +39-0743-222-601. [Contact in advance for current exchange rates and fees, if required.]

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