2013 WQI QUILTERS RETREAT/REUNION

April 4-7, 2013

Name______________________________________Phone__________

Street Address______________________________________________

City, State and Zip Code______________________________________

E-mail address_____________________________________________

Emergency Contact Name____________________________________

                                 Phone___________________________________

Roommate’s Name_________________________________________

____ $466 for Three Nights with Meals - Single Occupancy

____ $281 for Three Nights with Meals - Double Occupancy

____ $383 for Two Nights with Meals - Single Occupancy

____ $240 for Two Nights with Meals - Double Occupancy

Please list any food

allergies_________________________________________________

A non-refundable deposit of $100.00 must accompany your registration.  Balance of fees must be paid no later than January 31, 2013.

Mail your payment (checks made payable to Kathy Hicks) and this form to:

Kathy Hicks

N4625 Old Forest Rd.

Cambridge, WI  53523-9063

608-423-3717

mudpiepigs@frontier.com

Confirmation will be sent via e-mail.  If you do not have an e-mail address, please send a self-addressed stamped envelope.