QUILTERS RETREAT/REUNION

MAY 18-20, 2012

Name________________________________________Phone____________

Street Address__________________________________________________

City, State and Zip Code__________________________________________

E-Mail Address_________________________________________________

Emergency Contact Name________________________Phone____________

Roommate’s Name_______________________________________________

 _____$454 for Three nights with meals-Single occupancy

_____ $280 for Three Nights and Meals-Double Occupancy                          

_____ $375 for Two Nights and Meals-Single Occupancy                

_____ $240 for Two Nights and Meals-Double Occupancy                          

Please list any food allergies___________________________________________________________

A deposit of $100 must accompany your registration.  Balance of fees must be paid no later than February 15, 2012.

        

Mail your payment and this form to:

Kathy Hicks

N4625 Old Forest Rd.

Cambridge, WI  53523

608-423-3717

mudpiepigs@frontier.com

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