Registration and Payment for A Scraper’s Escape Scrapbook Retreats

    Please print clearly.  When registering with a friend or group, please complete one form for each attendee.
    A $50 deposit is required at time of reservation.  Registrations received less then 30 days prior to retreat
    must be paid in full.


    Name ________________________________________________________________________

    Address _______________________________________________________________________

    Home Phone #                                                Alternate/Cell # ______________________________

    E-mail address __________________________________________________________________


                      Aug. 22-24, 2008 Early Reg.
                       Aug. retreat reg. rcvd after 7/11/08
                       Oct. 24-26, 2008 Early Bird
                       Oct. retreat reg. rcvd after 9/12/08
                      Jan. 23-25, 2009 Early Reg.
                     Jan. retreat reg. rcvd after 12/1/08
                       April 24-26, 2009 Early Reg.
                       April retreat reg. rcvd after 3/14/09
                       Aug. 28-30, 2009 Early Bird
                       Aug. retreat reg. rcvd after 7/11/09
                       Oct. 23-25, 2009 Early Bird
                      Oct. retreat reg. rcvd after 9/12/09

               
    Sub-Total $                    
 
             Subtract Gift Certificate or coupons $                     
 
    Total enclosed  $                      


    Credit cards are accepted.  Please indicate next to the enclosed amount that you prefer to use a CC
    You will receive an e-mail invoice from ProPay, with a link to their secured server for payment.

    Name of desired roommate ________________________________________________________

    Who do you want to crop with ______________________________________________________

    What type of snacks do you enjoy while scrapbooking? __________________________________

    Do you have any food allergies or dietary restrictions? ___________________________________

    What beverages do you prefer?  • coffee; regular or decaf  • tea  • soda; regular or diet

    How did you hear about us? _______________________________________________________


    Make payments payable to T. Shotts and send to:  
    A Scrapper’s Escape Scrapbook Retreats
    PO BOX 3473, San Bernardino, CA 92413

    Contact us at: info@ascrappersescape.com
$225
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$250