REGISTRATION FORM

STURBRIDGE, MA
July 5-6, 2012

A deposit of $150 must accompany your registration form, with the final payment of $385 due on June 1, 2012. You may pay in increments. Make check or money order payable to “Stitcher's Hideaway”. Complete form, print out and mail with deposit to: Sue Donnelly, 172 Birch Street, Manchester, CT 06040.

If you prefer to use our PayPal payment option, return to the 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 $150. 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 June 1, 2012.  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: _________________

Special Order Scrimshaw Items: You may view these on the Project Page. These can be preordered and will be delivered to you in class.  Your payment for your scrimshaw order (by cash or check made out to “With My Needle”) must be given to Ellen at the retreat.  Please indicate how many of each piece you would like to order.  If none are desired, please indicate zero (“O”).

Bird with Grapes Arbor ruler (cost $30): _____________

Birds and Grape Arbor threadwinder (cost $38) __________

Joshua and Caleb threadwinder (cost $38):  ____________

Stitcher’s Hideaway^SM, 172 Birch Street, Manchester, CT 06040
©2002-2012 Stitcher's Hideaway, L.L.C./ All Rights Reserved