1Personal Data2Training3Housing and Travel4Financial Info LinkedInThis field is for validation purposes and should be left unchanged.Personal DetailsFirst Name(Required)Last Name(Required)Email(Required) Phone(Required)AddressAddress(Required) Street Address City State / Province / Region ZIP / Postal Code CountryAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Demographic InformationWe collect this information for internal use only. It will not be shared with any outside persons or groups. Racial IdentityWhiteBlack or African AmericanAsianNative Hawaiian and Other Pacific IslanderSome Other RaceMultiracialPrefer not to AnswerGenderMaleFemaleNon-binaryAgenderMy gender is not listedPrefer not to answerAgeUnder 1818-2425-3435-4445-5455-6465 or AbovePrefer Not to Answer Access NeedsSpecial Access Needs I do not have special access needs I have special access needs Please specifiy your needs below Training Level(Required)12Instructor ReferralNeeded for advanced training considerationFileFor advanced training consideration, we ask for an instructor referral. As an alternative, a pdf of your resume or documentation of relevant stage combat experience may be included here:Accepted file types: pdf, Max. file size: 15 MB. Do you need housing?(Required) Yes No Special AccomodationsDueling Arts International is committed to equitable and ethical inclusion. Are you in need of special accommodations? No Yes Please list your needed accomodations hereTravel Details(Required)You will be asked to provide your travel details one week prior to the first day of the workshop. Please respond with your commitment to provide specifics (flight arrival date and time, planned arrival by car, or local residence at workshop site). I will provide details ScholarshipScholarshipDueling Arts International offers scholarships based on financial need. If you wish to apply for one of the scholarships, you will be redirected to the application process after you submit this form. Sincere and thoughtful inquiries will be considered. I would like to apply DepositSecure your place in this course Price: Total You will be taken to PayPal's checkout system when you click submit. Do NOT close the window or cancel the process unless you want to cancel your submission.The process is considered complete when PayPal notifies you of payment success and you are redirected back to our website.You do NOT need a PayPal account to make the payment. You may use a credit card through PayPal's interface. How did you hear about this workshop? Referral by an Instructor Referral by a Friend Social Media (Facebook or Instagram) Workshop Flyer Other