Claudia Jurt - Intensive Scene Study
 Pre-Registration

Last Name: First Name: Middle Initial:

Permanent Address:

City: Province: Postal Code:

D.O.B.: (m)(d)(yr)     Age:

Home Tel: Cell/Pager:

Work: Email:

Medical & Allergy Alert - Please list any medical or allergy information that we should know:

Have you previously taken an A.C.T. course? Yes / No

ACT Permission & Photo Permission

In consideration of A.C.T. accepting me, , in the course noted below, I and my heirs do voluntarily waive and release each and every right or claim for damages we and each of us have or may have against the school, its agents or representatives for any and all injuries or mishaps howsoever occasioned.

I give permission for the use of photographs that may be taken during the workshop or other activities related to A.C.T. to be used by A.C.T. in promotional material for the school.  I understand that there will be no financial remuneration for the use of any photograph.

Name: Date:

Please check which course you would like to take:

AINTENSIVE SCENE STUDY A - MONDAYS 5:00-10:00, April 21-June 9 (5:00-10:00pm)
BINTENSIVE SCENE STUDY B - TUESDAYS 5:00-10:00, April 22-June 10
(5:00-10:00pm)

Cost: $375.00 + 5% GST = $393.75 Early Bird Discount: $350.00 (must pay by April 7) + 5% GST = $367.50 ACTRA/CAEA Members: $350.00 + 5% GST = $367.50      PRE-REQUISITE(S): By Invitation Only AUDITING COSTS: $20.00/class (+ 5% GST) = $21.00  OR        $145.00 (+ 5% GST) = $152.25 for the whole session To be considered for this class as a participant or auditor, please email your photo/resume to Info@ACTottawa.com and answer the following questions: 1. Why do you want/like to act? 2. Why do you want to take this class? 2.  What will you as an actor bring to this class? ALL NEW applicants MUST send a $100.00 deposit w/ answers to above questions, before their applications will be considered. Returning students only need to fill out this registration form.

Unless otherwise notified, the workshop will take place at Arts Court, 2 Daly Avenue, Ottawa, ON (between Waller and Nicholas Streets, across from the Novotel Hotel and the Rideau Centre)

Payment Options

AEarly Bird Discount (must pay by April 7) & ACTRA/CAEA Members and Apprentices - Attached, please find my signed registration form and my cheque
of $367.50 (incl. GST) in full payment.

BAfter April 7 (does not include ACTRA/CAEA Members) - Attached please find my signed registration form and my cheque of $393.75 (incl. GST) in full payment.

CAttached, please find my signed registration form and 3 Cheques.  A current cheque of $100.00 (to reserve my spot), together with my cheques of $150.00 (dated no later than April 28) and $143.75 or $117.50(ACTRA/CAEA members) dated no later than May 28, 2008.

DAUDITING ONLY - Attached please find my signed registration form and my cheque of $152.25 (incl. GST) in full payment.

Before you click the SUBMIT button below, please print this page and mail a copy with your cheque(s) payable to:  A.C.T.

Send your printed copy and cheque(s) to: