The Julia and David White Artists’ Colony in Costa Rica

RESERVATION FORM

Name: ___ Mr. ___ Ms. Last _______________ First ________________Middle ____

Email (essential for correspondence): _______________________________________

Telephone(s): Home: ________________________Work: _______________________

Cell: ________________________________ Fax: ______________________________

Street __________________________ City , State, Zip _________________________

Birthplace: __________Date of birth (optional): ___________ Citizenship: ________

Emergency Contact: _____________________________________________________

________________________________________________________________________

________________________________________________________________________

I would like to work in the following discipline at The Colony: __________________

My choices of month(s), dates and year:

1) Month(s) & Dates ____________________________________________ Year ____

2) Month(s) & Dates ____________________________________________ Year ____

3) Month(s) & Dates ____________________________________________ Year ____

I understand that s tays at The Colony are billed in two-week or month-long increments as follows: 14 days or less, $400 per artist or $650 for two artists sharing one space; Up to 29 days, $650 per artist or $900 for two artists sharing one space. Once I have been informed that the time I wish to be at The Colony is available, I will be asked to send payment for a minimum of half my total fee in the form of a check (in US dollars) made out to Sigmund Gaudi, S.A. and mailed to The Colony, Interlink 232, P.O. Box 526770, Miami, FL 33152. And that the balance will be due by no later than thirty days prior to the starting date of my stay.

Signature: _______________________________________________ Date: _________