Michèle Lonsdale Smith - Advanced Scene Study
 Pre-Registration

Click here for a printable form

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

How did you hear about A.C.T?

If "Other", please specify:

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:

DECEMBER 10-14, 2006 - (Sunday-Thursday)

GROUP A - 11:00am-3:00pm / GROUP B - 5:00pm-9:00pm

Cost: $425.00 + 6% GST = $450.50
Early Bird Discount: $399.00 (must pay by November 1) + 6% GST = $422.94
ACTRA Members and Apprentices: $399.00 + 6% GST = $422.94
** Please note: sometimes classes go later than scheduled **

PRE-REQUISITE(S): By Invitation Only

 AUDITING COSTS:
$30.00 (+ 6% GST) = $31.80 for Sunday, December 10
 $50.00/day (+ 6% GST) = $53.00 for December 11-14
OR $199.00 (+ 6% GST) = $210.94 for the whole week

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 study with Michèle
3. What will you as an actor bring to this class?

Former participants do not need to send a photo/resume, but ALL applicants MUST send a $100.00 deposit w/ answers to above questions, before their applications will be considered.

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 November 1) & ACTRA/CAEA Members and Apprentices - Attached, please find my signed registration form and my cheque
of $422.94 (incl. GST) in full payment.

BAfter November 1 (does not include ACTRA/CAEA Members) - Attached please find my signed registration form and my cheque of $450.50 (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 $200.00 (dated no later than November 20) and $150.50 or $122.94 (ACTRA/CAEA members) dated no later than December 6, 2006..

DAUDITING ONLY - Attached please find my signed registration form and my cheque of $210.94 (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:

A.C.T. | RE: Michèle Lonsdale Smith Workshop | 2 Daly Ave. Ottawa, Ontario K1N 6E2

Pre-Registration Forms will be held for one week. If no payment is received within 7 days, your Pre-Registration will become void.

REFUND POLICY:

If you are unable to attend due to illness, we will accept a medical letter no later than one week before the course begins.  A refund minus an administration fee will be given at that time.

Please note that participating in this workshop does in no way guarantee talent representation or any performance related work to the participant.