RED CINDER CREATIVITY CENTER Where Ideas Catch Fire on the Big Island of Hawai'i Helen Chellin, Director Mainland Address: 243 Jersey Street San Francisco, CA 94114 Phone: 415 821 6694 Fax: 415 648 8131 Island Address: P.O. Box 527 Na'ahelu, HI 96772 Phone: 808 929 9600 Caretakers, Patty and Drake Fujimoto Phone: 808 929 8426 LEARNING CENTER APPLICATION 1. Workshop leader Name: __________________________________________ Address: _______________________________________ City: __________________________________________ State/Zip: _____________________________________ Day phone: _____________________________________ Evening phone: _________________________________ Fax: ___________________________________________ E-mail: ________________________________________ Driver's License # _________________ State _____ 2. Topic or discipline of workshop 3. Brief description 4. Number of participants (indicate any couples who would share a room) __________ 5. List three possible dates in order of preference: a. ____________________ b.______________________ c.____________________ 6. Any special requests of site (include menu preference):