Application Form
Nancy Stark Smith January Workshop 2010

Thank you for your interest in the NSS January Workshop 2010!

To apply and pay $160 deposit: 2 options:

1. Online Fill in online form and pay deposit via PayPal. Submit & Pay button below.
2. By post : Send completed application form and $160 deposit in check or bank money order (in U.S. funds, drawn on a U.S. bank). Checks payable to: Contact Collaborations. Send to: NSS January Workshop, c/o Contact Collaborations, P.O. Box 603, Northampton, MA 01061.

Early Registration Date: November 1, 2009
Applications must be approved by Nancy before registration is confirmed. (If not approved, your deposit is refunded.)
Tuition balance is due by: December 15, 2009

Application

first name

last name

street

zip

city

state

country

phone (between now and Jan. 4)

cell phone

email

retype your email

age
gender

Description of your previous experience and skill level with Contact Improvisation, dance, and Improvisation. Please be specific about the CI teachers you’ve worked with, # of years of practice, and situations (college class, workshop, festival, jam) and the duration of the classes/workshops.


If you would like to send a CV, please send it to: januaryworkshop@nancystarksmith.com

More about you and CI: What areas are your strengths in CI? What areas challenge you the most? What overall level of Contact Improvisor do you consider yourself to be? (beginner, advanced beginner, intermediate, advanced)

Your reasons for wanting to attend the workshop and your current areas of interest in the work
Language:  The course will be taught in english. Basic fluency in English is required. Please indicate you English level
Other languages you speak ?     

Name of two References and their e-mail :
Please ask your references to write a brief note about you: your CI, dance, and improvisation experience; and your participation in groups. Reference’s notes should be emailed to Nancy at januaryworkshop@nancystarksmith.com.

(fill in "---" if not available)

Name Email
Name Email
(people who know you and your experience level in contact improvisation, dance, and other improvisational dance work)

Transportation:
How will you be traveling ?

Please drive, if possible. We will need vehicles for carpooling to town workshop sites, so please bring your car if you can. Thank you!

Driving? Getting a ride? Flying? Other? :

If flying, what city will you fly into? :

$160 Deposit Payment

Contact: Patrick Crowley, Workshop coordinator, with any questions. januaryworkshop@nancystarksmith.com; (617) 320-9792