| Title |
|
|
| First Name |
* |
|
| Surname |
* |
|
| Organisation |
|
|
| Role |
|
|
| Postal Address |
|
|
| |
|
|
| Town / State |
|
|
| Postcode |
* |
|
| Telephone |
* |
|
| Mobile |
|
|
| Email |
* |
|
What ARTFORM you you work in?
(please tick all relevant) |
|
(specify)
|
Your ROLE in cultural events?
(please tick all relevant) |
|
(specify)
|
Diversity group?
(please tick all that apply to you,
or groups you work with) |
|
|
Which workshops would you like to attend? |
|
| MALLACOOTA | Venue: The Mudbrick Pavilion, Maurice Ave, Mallacoota |
| Wednesday 10 November, 10.00am – 12.00pm
| Wednesday 10 November, 1.30pm – 3.30pm
| Wednesday 10 November, 4.30pm – 6.30pm
|
|
| BAIRNSDALE | Venues: Bairnsdale Neighbourhood House, 27 Dalmahoy Street, Bairnsdale |
| Wednesday 10 November, 10.00am - 12.30pm, Bairnsdale Neighbourhood House
| Friday 12 November, 10.00am - 12.30pm, G-tec, (TAFE Arts Campus)
| Friday 12 November, 2.00pm - 4.30pm, G-tec, (TAFE Arts Campus)
|
|
| LAKES ENTRANCE | Venue: East Gippsland Shire Council Chambers, 55 Palmers Road, Lakes Entrance |
| Wednesday 10 November, 2.30pm - 5.00pm
| Thursday 11 November, 10.00am - 12.30pm
|
|
| ORBOST | Venue: Orbost Business Centre, 1 Ruskin Street, Orbost |
| Thursday 11 November, 10.00am - 12.30pm
| Thursday 11 November, 2.00pm - 4.30pm
|
|
|
|
| I have special access needs |
|
|
| Please call me to discuss: |
|
|
| |
|
|
TERMS & CONDITIONS: YOUR PLACE is only confirmed when you are advised by us. Should you be unable to attend ANY WORKSHOP BOOKED, please notify us ASAP. AMAG intends to run this program as advertised, however we reserve the right to alter the program and speakers without further notice due to exceptional or unforeseen circumstances. AMAG reserves the right to cancel this program due to insufficient numbers. If this happens, registered participants will be notified.
I have read, and agree to, the Terms and Conditions of Registration *
|
| |
|
|
