Martha Wakeman

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To ask questions or comment, please fill out the form below and click “SUBMIT” <form method="POST" name="contactus" action="http://www.marthawakeman.com/index.php"> <input type="hidden" name="redirect" value="http://www.marthawakeman.com/index.php/static/category/section/thankyou/"> <input type="hidden" name="emailfields" value="Email"> <input type="hidden" name="emailtemplate" value="mwstudy_email.txt"> <input type="hidden" name="filetemplate" value="mwstudy_data.txt"> <input type="hidden" name="dbfile" value="mwstudydata.csv"> <div class="widget"> <fieldset id="Purpose" class="required"> <legend>Reservation(s) or Inquiry</legend> <div class="instructions">Are you submitting this form to make a reservation or to submit an inquiry or comment?</div> <span class="required"> <span class="oneChoice"> <input type="checkbox" value="yes" id="Reservation" name="Reservation" /> <label for="wf_Drawing" id="wf_Drawing-L" class="postField">Reservation(s)</label> </span> <span class="oneChoice"> <input type="checkbox" value="yes" id="Inquiry" name="Inquiry" /> <label for="wf_Pastel" id="wf_Pastel-L" class="postField">Questions/Comments</label></span> </span> <div class="instructions">If this is a reservation, for how many people? <input type="text" size="3" id="number" name="Number" value="" class="none required" style="width: 20px;" /></div>  </fieldset> <fieldset id="wf_ContactInformatio" class="required"> <legend>Contact Information</legend> <div class="instructions">Please fill out the form below. Use the name exactly as listed on your passport.</div> <div class="preField"><b>For the First Reservation:</b></div> <label for="FirstName" id="FirstName-L" class="preField">First Name:</label> <input type="text" id="FirstName" name="FirstName" value="" class="none required" /> <br /> <label for="MiddleName" id="MiddleName-L" class="preField">Middle Name/Initial:</label> <input type="text" id="MiddleName" name="MiddleName" value="" class="none required" /> <br /> <label for="LastName" id="LastName-L" class="preField">Last Name:</label> <input type="text" id="LastName" name="LastName" value="" class="none required" /> <br /> <label for="Email" id="Email-L" class="preField">Email Address:</label> <input type="text" id="Email" name="Email" value="" class="validate-email required" /> <br /> <label for="StreetAddress" id="StreetAddress-L" class="preField">Street Address:</label> <input type="text" id="StreetAddress" name="StreetAddress" value="" class="none required" /> <br /> <label for="City" id="City-L" class="preField">City:</label> <input type="text" id="City" name="City" value="" class="none required" /> <br /> <label for="StateProvince" id="StateProvince-L" class="preField">State/Province:</label> <input type="text" id="StateProvince" name="StateProvince" value="" class="none required" /> <br /> <label for="ZipPostalCode" id="ZipPostalCode-L" class="preField">Zip/Postal Code:</label> <input type="text" id="ZipPostalCode" name="ZipPostalCode" value="" class="none required" /> <br /> <label for="Telephone" id="Telephone-L" class="preField">Telephone:</label> <input type="text" id="Telephone" name="Telephone" value="" class="none required" /> <br /><br /> <div class="preField"><b>For the Second Reservation:</b></div> <label for="FirstNameS" id="FirstName-LS" class="preField">First Name:</label> <input type="text" id="FirstNameS" name="FirstNameS" value="" class="none required" /> <br /> <label for="MiddleNameS" id="MiddleName-LS" class="preField">Middle Name/Initial:</label> <input type="text" id="MiddleNameS" name="MiddleNameS" value="" class="none required" /> <br /> <label for="LastNameS" id="LastName-LS" class="preField">Last Name:</label> <input type="text" id="LastNameS" name="LastNameS" value="" class="none required" /> <br /> <label for="EmailS" id="Email-LS" class="preField">Email Address:</label> <input type="text" id="EmailS" name="EmailS" value="" class="validate-email required" /> <br /> <label for="StreetAddressS" id="StreetAddress-LS" class="preField">Street Address:</label> <input type="text" id="StreetAddressS" name="StreetAddressS" value="" class="none required" /> <br /> <label for="CityS" id="City-LS" class="preField">City:</label> <input type="text" id="CityS" name="CityS" value="" class="none required" /> <br /> <label for="StateProvinceS" id="StateProvince-LS" class="preField">State/Province:</label> <input type="text" id="StateProvinceS" name="StateProvinceS" value="" class="none required" /> <br /> <label for="ZipPostalCodeS" id="ZipPostalCode-LS" class="preField">Zip/Postal Code:</label> <input type="text" id="ZipPostalCodeS" name="ZipPostalCodeS" value="" class="none required" /> <br /> <label for="TelephoneS" id="Telephone-LS" class="preField">Telephone:</label> <input type="text" id="TelephoneS" name="TelephoneS" value="" class="none required" /> <br /> </fieldset> <fieldset id="wf_Classes" class="required"> <legend>Classes</legend> <div class="instructions">Please select the class(es) you would like to take during the week.</div> <span class="label preField">Select Class(es):</span> <span class="required"> <span class="oneChoice"> <input type="checkbox" value="yes" id="Drawing" name="Drawing" /> <label for="Drawing" id="Drawing-L" class="postField">Drawing</label> </span> <span class="oneChoice"> <input type="checkbox" value="yes" id="Pastel" name="Pastel" /> <label for="Pastel" id="Pastel-L" class="postField">Pastel</label> </span>  </span> <br /> </fieldset> <fieldset id="wf_Query" class="required"> <legend>Questions or Comments</legend> <div class="instructions">If you have questions or comments, please type them in here.</div> <label for="query" id="query" class="preField">Question:</label> <textarea name="query" cols="40" rows="10" wrap="virtual" class="none required" id="query" value="">

Terms and Conditions - for Reservations

Please read the terms and conditions below and check YES if you accept them or NO if you do not. Note: reservations will not be accepted if you select NO.

Terms and Conditions:
Reservations are based on a first-come, first-served basis. To guarantee your reservation a deposit of $250.00 for each person in your party is due by January 31, 2014. Payment in full must be received by March 31, 2014. Checks should be made out to "Art and Study Retreats in Italy" and mailed to:
Art Retreat
Martha Wakeman
105 Oneco Avenue
New London, CT 06320-4120

You may also make payments online via PayPal using a credit card or your PayPal account: Fee Payment

Martha Wakeman and Robert Proctor, d.b.a Art and Study Retreats in Italy, are the tour operators and are responsible for the services provided. However, in the absence of negligence on its part, the tour operators are not responsible for personal injury or property damage arising out of the act of negligence of any direct carrier, hotel or travel services or other person rendering any of the services connected with the tour.

I accept the Terms and Conditions: YES, I accept the terms and conditions.
NO, I do not accept the terms and conditions.

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