Name_________________________________________________

Address________________________________________________
______________________________________________________

Phone #________________________________________________

E-mail address___________________________________________
(Used for confirming your registration)  
 Please print clearly.

*Please check which type of weekend you are registering for*

Scrapbooking____  Quilting____ Free For All_____

Date to book ________________________________________

check-in time 5 p.m. Thursday_______
        10 a.m. Friday_________
($25.00 deposit per person)
Please make check  made out to  A Time To Create

Check number_______  Amount of check_________  

How did you hear about us?________________________________________

Is this your first visit with us?    yes_____      no_____

The coordinator  of my group is

____________________________________

Yes, I would like to book a massage______  
Must be booked in advance but  paid for at the time of massage

Please print form and mail to:
A Time to Create
4976 181st Street
Chippewa Falls, WI 54729