Raconteurs EOI

All correspondence will be generated from the personal information submitted below. So, please use correct spelling, capitalisation and punctuation.
I. Contact details:

Tell us about yourself
First NameLast Name
Home Address :*

Street Address

Street Address Line 2

City / TownState / Territory

Post CodeCountry
E-mail :*
Where the confirmation will be sent
Your Preferred Phone No.:*
Do not include spaces
Your Preferred method of contact*

EmailMobile / TextTelephoneOther
Birthdate:*

DayMonthYear
Do you require assistance filling out this form?*

YesNo
If you answered Yes, what is the full name of person filling out this form

First NameLast Name
Relationship to applicant:
Preferred Phone No.:
Do not include spaces
E-mail :
Where the confirmation will be sent
II. Creative Experience:
I am interested in disability-inclusive arts practice*

YesNo
I am interested in:

DanceTheatreMusicWritingStreet PerformanceMulti ArtformsStory Telling
Short biography (no more than 200 words):*

0/200
III. Availability and Interest:
The Raconteurs workshops are available in pre-selected 'BUNDLES' or you are able to choose the individual workshops you would like to attend.
BUNDLE 1

Writing a Life - Mark Swivel
Provocation & Curiosity - Kimberley McIntyre & Alona Rosenberg
Embodying Macro & Micro - Philip Channells
Story - Entwining - Bere
Reverse Engineering The Shannon Technique - Bill Shannon
Interdisciplinary Art in Public Space: A2B - Bill Shannon
BUNDLE 1

$350 waged$300 concession
BUNDLE 2

Writing a Life - Mark Swivel
Provocation & Curiosity - Kimberley McIntyre & Alona Rosenberg
Embodying Macro & Micro - Philip Channells
Story - Entwining - Bere
Reverse Engineering The Shannon Technique - Bill Shannon
Sound Play - Pob Sellers
BUNDLE 2

$350 waged$300 concession
BUNDLE 3

Provocation & Curiosity - Kimberley McIntyre & Alona Rosenberg
Embodying Macro & Micro - Philip Channells
Reverse Engineering The Shannon Technique - Bill Shannon
Interdisciplinary Art in Public Space: A2B - Bill Shannon
BUNDLE 3

$260 waged$220 concession
BUNDLE 4

Writing a Life - Mark Swivel
Embodying Macro & Micro - Philip Channells
Story - Entwining - Bere
Interdisciplinary Art in Public Space: A2B - Bill Shannon
BUNDLE 4

$240 waged$210 concession
Raconteur Workshop Series
Writing a Life - Mark Swivel

$60 waged$50 concession
Provocation & Curiosity - Kimberley McIntyre & Alona Rosenberg

$80 waged$70 concession
Embodying Macro & Micro - Philip Channells

$80 waged$70 concession
Story Telling & Journeying - Bere

$80 waged$70 concession
Reverse Engineering The Shannon Technique - Bill Shannon

$90 waged$75 concession
Sound Play - Pob Sellers

$120 waged$100 concession
Interdisciplinary Art in Public Space: A2B - Bill Shannon

$120 waged$100 concession
NB. Please be aware that Sound Play and Interdisciplinary Art in Public Space: A2B run concurrently. You will not be able to take part in both of these workshops.

Prices listed are for the complete workshop series. Further concessions and refunds will not be available if you do not attend all sessions.
IV. Access Requirements:
Do you have a disability?*

YesNo
Comment:
I have access requirements?*

YesNo
Comment:
I have specific access needs and would like to attend Raconteurs with a friend / colleague / family member who will support me during the workshops.

YesNon/a
Will they also participate in the workshops?

YesNo
Family member, Friend or Colleague?
Support person's name

First NameLast Name
E-mail
Preferred Phone No.:
Do not include spaces
I have medical requirements?*

YesNo
Comment:
I need transport assistance to the workshops*

YesNo
Comment:
I would like to discuss my access & transport needs and medical requirements and any other support needs I have through my preferred method of contact.*

YesNon/a
Comment:
V. Financial Investment
NOTE: A Financial Agreement Form will be emailed to you to once we have processed your application. Please check you have provided us the correct email account details.
I would like to apply for a payment plan.*

YesNo
I agree to pay in full by 5pm Friday 10 November 2017*

Yes
VI. Additional information
Any additional information you would like us to know:

0/500
VII. Authorisation and Consent
I have read and understood the information regarding Raconteurs and give my consent to participate and be photographed / videod for promotional purposes. I also consent for contact bewteen Dance Integrated Australia and volunteers to take place.*

YesNo
I understand that any bullying, failing to co-operate with the collaborators and artistic process and any other inapproriate behavior deemed to have a negative impact on my or other particpant’s health & well being, and the reputation of the Raconteurs program, Dance Integrated Australia reserve the right to terminate my residency at my own expense.*

Yes
VIII. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct at the time of completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:*
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Should be Empty:

I. Contact details:

II. Creative Experience:

III. Availability and Interest:

IV. Access Requirements:

V. Financial Investment

VI. Additional information

VII. Authorisation and Consent

VIII. Applicant's E-Signature