Quilting On The Rim  

Registration Form

Date:  ___________________________

Contact Name: _____________________________________________  

Address:  _________________________________________________

Phone:  ______________________    E-mail:  _____________________  

Requested Retreat Date: _____________ Alternate Date: ____________

Number & Name of guests in your party (6 guest minimum)    ___________ 

___________________________________    ____________________________________  

___________________________________    ____________________________________  

___________________________________    ____________________________________

___________________________________    ____________________________________  

___________________________________    ____________________________________ 

If you have less than 10 guests, is it OK to add guests to your weekend? ________

Deposit:  ($50 per guest to hold your weekend, $300 Minimum): _____________

For more information or questions please call Barbara at:   602-618-6371 or Barb@QuiltingOnTheRim.com Please mail this form with deposit check to:  
Barbara Heleniak
1207 Elliott Lane, Show Low, AZ  85901