| Name_________________________________________________ Address________________________________________________ ______________________________________________________ Phone #________________________________________________ E-mail address___________________________________________ (Used for confirming your registration-please write clearly) Please print clearly. Scrapbooking/Stamping_______ Quilting______ Free For All______ Please enter date you wish to attend___________________________ Please enter check-in time 10 a.m.or 5 p.m._____________________ (minimum of four quests for early check-in) Credit Card#_____________________________________________ 3 digit # from back of card_________________ Exp. Date on card_______________________ Name as it appears on card_______________________________ We take *Master Card* * Visa* and *Discover* or enclose nonrefundable $25.00 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_____ I am booking with a group and their names are: 1.______________________________2.______________________________ 3.______________________________4.______________________________ 5.______________________________6.______________________________ 7.______________________________8._____________________________ 9._____________________________ Yes, I would like to book a massage______ or pedicure______ Must be booked in advance but paid for at the time of massage or pedicure Please print form and mail to: A Time to Create 4976 181st Street Chippewa Falls, WI 54729 |
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