AGREEMENT & APPLICATION
Convivio Conference
June 13-22, 2022
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Email *
First Name *
Last Name *
Address *
Phone *
Emergency Contact Name *
Emergency Contact Phone *
Emergency Contact Email *
Passport Expiration Date *
Please state any personal information that you believe will help us provide you with a safe and enjoyable experience in Italy (e.g., medical conditions; food, drug, or other allergies; physical limitations; medications; specific dietary restrictions; or any other special needs):
Please state your primary interest in attending (e.g., poetry instruction, nonfiction instruction, visual art instruction, choral-singing instruction, intellectual curiosity, Italian cultural exploration, etc.).  Poetry readings and workshops as participant, and as instructor, offering responses to peoples' work, and/or  teaching discussion-based, generative workshops.
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