12th INTERNATIONAL SCULPTURE IN STONE SYMPOSIUM  
17th of May – 28th of May 2012 BORKEL EN SCHAFT, THE NETHERLANDS

Please fill in and mail this form back to:
Jan van de Pol
De Wolfsputten 4
5709 PB Helmond
The Netherlands

APPLICATION  FORM

I, the undersigned___________________________________________________

No/ Street__________________________________________________________

Place/Country_______________________________________________________

Telephone_______________________  E-mail_____________________________

wish to enrol for the working and exhibition weeks in Borkel & Schaft from 17th of may till
28th of may 2012 (exhibition till 3th of June) and declare to be fully aware of the conditions described above.

Date

Signature