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
Birthdate:

DayMonthYear
Do you require assistance filling out this form?
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
I am interested in:
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
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
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
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
Raconteur Workshop Series
Writing a Life - Mark Swivel
Provocation & Curiosity - Kimberley McIntyre & Alona Rosenberg
Embodying Macro & Micro - Philip Channells
Story Telling & Journeying - Bere
Reverse Engineering The Shannon Technique - Bill Shannon
Sound Play - Pob Sellers
Interdisciplinary Art in Public Space: A2B - Bill Shannon
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?
Comment:
I have access requirements?
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.
Will they also participate in the workshops?
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?
Comment:
I need transport assistance to the workshops
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.
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.
I agree to pay in full by 5pm Friday 10 November 2017
VI. Additional information
Any additional information you would like us to know:

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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.
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.
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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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