Application Form - La MaMa Umbria International Playwright Retreat 2018

Retreat Dates: August 2-12, 2018

Artist-in-Residence: Migdalia Cruz

Email address *
Name: *
Your answer
Your answer
City: *
Your answer
State: *
Your answer
Zip: *
Your answer
Country: *
Your answer
Email: *
Your answer
Your answer
Telephone Number (1): *
Your answer
Telephone Number (2):
Your answer
Date of Birth: *
Your answer
Special Dietary Requirements:
(please specify)
Your answer
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? *
Your answer
How might this experience help you as an artist? *
Your answer
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.
Your answer
What do you hope to achieve during the retreat to consider it successful? *
Your answer
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)

Umbria Playwright Retreat (Full Payment)

- OR -

You may send a check in US$ made payable to La MaMa ETC addressed to:

La MaMa Umbria Playwrights Retreat
66 East 4th Street, 3rd Floor
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 or calling +39-0743-222-601. [Contact in advance for current exchange rates and fees, if required.]

Please attach your resume and email it to David Diamond at
For further information, please contact:
David J. Diamond, Symposium Coordinator, (212) 620-0703,
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms