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Please complete and submit your request at least 2-3 weeks prior to your desired date of retreat. Spaces are reserved according to prior requests and current availability.
Applying for: ______ 1-Week Residency ______ 2-Week Residency
______ 1-Week Residency ______ 2-Week Residency ______ Weekend Only______ 4 days or lessPreferred Dates (You may choose order of preference — 1, 2, or 3)
(Please indicate whether you will be arriving or leaving on a different day than shown.)
_____ May 7 – 13 _____June 18 –24
May 7 – 13 _____June 18 –24 _____May 14 – 20 _____July 9 –15
May 14 – 20 _____July 9 –15 _____May 21 – May 27 _____August 6 - 12
May 21 – May 27 _____August 6 - 12_____June 4 – 10 _____August 13 – 19
June 4 – 10 _____August 13 – 19_____June 11 –17
June 11 –17 Name of Artist:__________________________________________________
__________________________________________________Street address:__________________________________________________
__________________________________________________City: State: Zip: County:__________________________________________________
__________________________________________________Phones (home & cell):__________________________________________________
__________________________________________________Email address: __________________________________________________
__________________________________________________Emergency Name/Phone: __________________________________________________
__________________________________________________How did you learn about PenHouse Retreat Center? ________________________________
____________________________________________________________________________________________________________
Please check the nature of your visit:
_____ This Year I Write Participant_____ Other Workshop Participant
_____ Other Workshop Participant_____ Individual Retreat _____ Group Retreat
_____ Group RetreatGroup rates for 3-5 members receive a 10% discount on the daily rate. Individual $50.00 daily rate. Includes 3 prepared meals at PenHouse Retreat Center. Most meals will come from garden produce and local farmers’ market. Please indicate if you have special dietary restrictions: _____________________________________________________________________________________
_____________________________________________________________________________________
A letter confirming the dates, time of your stay, directions to PenHouse Retreat Center and other pertinent details will be send to your email address. We must have your email address.
Send application to:Normandi Ellis / PenHouse Retreat Center
Normandi Ellis / PenHouse Retreat Center 2367 Sullivan Lane Frankfort KY 40601Questions? Call: 502-352-7503 or E-mail: ellisisis@gmail.com
PENHOUSE RETREAT
CENTER
2012 Summer Residency Program Application
