Retreat

May 15-17, 2015

Riyala

Noonamah, NT

APPLICATION FORM

Note that only those who are new to TEARlink need complete this form. Others should contact Barbara at (0431 397 771) to let her know they are coming.

Applications are due into TEAR Australia by 1 May, 2015

Name (title)______

Address______

______Postcode______

Daytime phone ( ) ______

After hours phone ( )______

Email______

Your current involvement in work with Indigenous communities:

A brief history of your previous involvements in Indigenous work:

Attendees

Please complete for yourself and any attending with you:

(Please note that there is no special children’s program)

NAME / SEX / AGE / SPECIAL DIETARY NEEDS

Accommodation

Accommodation at Riyala is in shared rooms. There may be some individual rooms, depending on final numbers. There are shared bathroom and toilet facilities. Bedding and towels are supplied.

Please room me with ______

If available, I would like a private room

Costs

TYPE OF BOOKING / COST / NUMBER / TOTAL
Full retreat
2 nights accommodation plus meals (Friday evening til Sunday afternoon, 15-17 May / $180
Part retreat
1 night’s accommodation plus meals
(Saturday til Sunday afternoon) / $130
Day visitor only
Lunch, tea, coffee and snacks provided
(Saturday or Sunday) / $35 per day
Day visitor plus 2 evening meals
(Friday, Saturday) / $80
TOTAL
I PLAN TO CAMP AND CATER FOR MYSELF FOR THE WEEKEND: $50

Payment

I enclose a cheque payable to TEAR Australia

OR

Please charge my: Mastercard Visa Amex

Total amount $______

Card Number: ______

Expiry date: ______/______Signature:______

Send to:

Elizabeth Wilkinson

(Phone 03 9264 7026)

TEAR Australia, PO Box 164, Blackburn 3130, Victoria.

CC to:

Barbara Deutschmann

(Phone 0431 397 771)

TEAR Australia respects your privacy and complies with National Privacy Principles. We will not disclose your details to any third party, other than for mail and bank processing. Access TEAR’s Privacy Policy at www.tear.org.au.

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