Application Form

To use this form please press print on your browser, and then send it to:

Mr H. Hood, Berllanderi Sculpture Workshop, Usk Road, Raglan, Monmouthshire, NP15 2HR Wales, UK

Name:

Address:

Telephone Number:

Any other forms of communication (e.g. fax, mobile or email)

When would you like to stay at Berllanderi:

From:

To:

Names and addresses of two referees

What technical equipment would you need for your stay? (for example, Gas Welding equipment)

Describe how you intend to use your time, i.e. working towards an exhibition.