VIAR Registration Form

Name__________________________________
Art Medium_____________________________
Choose a Session: July_____ September_____

Interests for Retreat include:

Painting ____ Writing ____ Golf ____ Walking ____ Pubs ____ Music ____
Photography ____ Irish Dancing _____ Shops_____ Ruins____
Other _____________

Address______________________________________________________________

Email________________________________________________________________

Phone________________________________________________________________

Roommate_____________________________________________________________

Amt of deposit__________________________

Check____________

Print out this page and Mail registration to:
Valentia Island Artist’s Retreat
c/o Barbara Mastaglio
913 Colonial Avenue
Norfolk, Virginia 23507 USA
757-718-8876 OR 757-622-2503

Please make checks payable to Barbara Mastaglio