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_____
(food and pampering included)
0R

Just Wanna Scrap Weekend_____

Date __________________________________________________

check-in time 5 p.m. Thursday_______
             10 a.m. Friday_________

Please make check  made out to  A Time To Create
Check number_______  Amount of check_________  
Please be aware we will no longer be taking credit cards for payment.
Check or cash only please.

How did you hear about us?________________________________________

Is this your first visit with us?    yes_____      no_____

I am booking with a group and the coordinators  name 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