REGISTRATION FORM

MYSTIC ONE
October 21-22, 2011

This retreat is full - wait list only.

A deposit of $100 must accompany your registration form, with the final payment of $350 due on September 15, 2011 (you may pay your balance in increments). Make check or money order payable to “Stitcher's Hideaway”. Complete form, print out and mail with deposit to: Sue Donnelly, Stitcher’s Hideaway, 172 Birch Street, Manchester, CT 06040.

If you prefer to use our PayPal payment option, return to main page of the website for instructions. Fees for Stitcher's Hideaway do not include hotel. You must make hotel arrangements separately.

Name:__________________________________________________________________________________

Address: _______________________________________________________________________________

City: ________________________________ State: _____________ Zip: _______________

Day Phone: ________________ Evening Phone: _________________ Cell Phone: ___________________

E-Mail: ____________________________________________________________________

Would you like to be matched up with someone requesting a roommate? _____ Yes                  _____ No

Do you have any food allergies or other dietary concerns?___________________________________________

IMPORTANT - READ CAREFULLY

Registration Policies:
- Registrations must be accompanied by deposit of $100. You may send a check or pay through PayPal (see Registration page for PayPal instructions.)
- Registrations will be processed in order of date and time received.
- All registrations MUST include at least one telephone number.
- Confirmations will be sent by email as registrations are received.
- Please read and sign below or form will be returned to you, delaying your registration.

Cancellation Policy
All requests for cancellation must be made in writing (email accepted).
A refund will be issued only if your space can be filled, and there will be a $40 processing fee for cancellation -- no exceptions. Please allow approximately three weeks to process cancellation. Please be aware that there will be no refunds for cancellations that occur after September 15, 2011.  If the retreat is cancelled for any reason, you will receive a 100% refund.

I have read and agree to the above Registration and Cancellation policies.


Signature: ________________________________________________ Date: _________________