Kakiseni International Arts Festival

“Appearance” Human Size Puppet and Mask Making Technic Workshop by Natacha Belova

Registration Form

Date : 1st – 11th September 2014 (11 days) Time : 10am – 5pm (with one hour lunch break) Venue: Five Arts Centre 27 Lorong Datuk Sulaiman 7, 60000 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur. Language : Conducted in French with English & Mandarin interpreter Intake of participants : 16 persons max. Fees : Malaysian citizens - RM 700 Non-Malaysian citizens - RM1,000

** Materials cost is not included **

早鳥优惠价 Early bird sign-up price - RM 500 dateline 10th August *** only for Malaysian citizens *** 只限馬來西亞公民

Enquiries [email protected] or

CALL 016-3409534 (Eugene) / 012-3826198 (Gigi) Registration deadline

24th August 2014

Number of participants is limited, kindly register as soon as possible. Note :

Please email the completed form together with your CV to 1. [email protected]. Confirmation is subjected to availability. 2. The workshop fees MUST be paid within 3 days once the application is confirmed. Otherwise, the 3. organiser retains the right to cancel your application. The workshop fees are non-refundable but transferable. 4. Successful applicants will be notified via email or phone. 5. Payment: 6. a) Pay CASH directly to the person in charge of the workshop OR

b) Bank directly into our account OR

c) Issue a cheque in favour of Capri Communications Sdn Bhd Bank Account detial: 7. Bank: CIMB Bank

Account Name: Capri Communications Sdn Bhd

Account Number: 12250004725057 IMPORTANT: Kindly RETAIN the deposit slip for further verification. 8. Please provide your details (name and no. of the deposit slip) via phone or email after the deposit. 9. The organiser shall not be held liable for any loss, damage, injury and/or any mishap that may occur 10. during this workshop. Participants are to prepare their own materials. List of required materials will be provided after 11. confirmation. The final artworks of each participant belong to them at the end of the festival. 12.

注意事項: 1. 請將填妥之表格連同你的個人履歷電郵至 [email protected]。

2. 錄取程序採用先到先得制。

3. 報名确認成功後需在 3 天内繳交研習費。如沒在指定限期內繳交研習費，主辦單位

有權把名額轉讓給其他報名者。

4. 費用一經繳付，概不退還，但可更換參與者。

5. 將以电邮或電話通知錄取者。

6. 繳費方式:

a) 親自把費用交給工作坊負責人

b) ATM 轉帳付費或支票匯款。

銀行戶口名字：Capri Communications Sdn Bhd

銀行： CIMB Bank

帳號： 12250004725057

7. 請務必保留提款機列印的收執聯或任何匯款回條，做為報名證明。

8. 匯款後請以電話或電郵的方式和我們聯絡，以確認您的姓名及匯款帳號。

9. 活動期間，參與者倘有受傷、疾病或財物損失，概與主辦機構無關。

10. 學員須自備製作材料。主辦單位

提供有關材料清單。

11. 由學員創作與製作的活偶與面具成品將歸學員所有。

I hereby agree:

• To participate in the Natacha Belova Appearance Workshop (1-11 September 2014).

• To be videotaped and/or photographed while participating in the Natacha Belova

“ Appearance” Workshop. (Photos and video footage of participants will be used for

archival and promotional purposes only).

• The organiser shall not be held liable for any loss, damage, injury and/or any mishap

that may occur during this master class.

• To participate in the outdoor performance of Kakiseni International Arts Festival 2014 (12-16 September 2014) with the puppet creation of this workshop.

我同意:

• 參加 Natacha Belova 活偶与面具制作工作坊(2014 年 9 月 1 至 11 日)。 • 工作坊期間讓主辦單位拍照、錄影和錄音以作宣傳或存檔用途。

• 活動期間，參與者倘有受傷、疾病或財物損失，概與主辦單位無關。

• 携带本人在工作坊期間製作的活偶與面具成品参与 Kakiseni International Arts Festival

（2014 年 9 月 12 至 16 日）之户外演出。

Name 姓名:

NRIC or Passport No 身分證或護照號碼:

Date 日期 :

＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿ Participant’s Signature 參與者簽名

Please fill in your personal particulars on the next page. 請翻頁，填 妥 您 的個人資料。

Personal Particulars 個人資料 （Please attach your CV together with this submission. 申請时请 附上個人履歷。) Name 姓名: Gender 性别: ( 男 M / 女 F ) Date of Birth 出生日期: NRIC or Passport No 身份 證或護照號碼: Contact No. 聯絡號碼: (Mobile 手機) (Home 住家) Email 電郵: Address 地址:

Nationality 國籍: Do you have any medical condition(s)? (eg. Asthma, anemia, etc) 你有沒有任何健康的問題？（如哮喘、貧血等）

Do you have any food or drug allergies? 你有沒有食物或藥物敏感？

Please tick (✓) if you are a vegetarian. 如果你 是素食者請在此劃勾。

I prefer to receive the confirmation of successful applicants via: 我希望以以下方式獲取報名确認通知： Email ／ 電邮 Phone call ／電話通知

In case of emergency, please contact: 如有緊急狀況，請聯絡：

Name 姓名: Contact 聯絡:

Relationship 關係: