* Cost (enter from information above): 

* Please Choose a Retreat:  Choose One Santa Cruz, Oct 2-5 Missouri, Nov 6-9

* First Name: 

* Last Name: 

* Phone Number (XXX-XXX-XXXX): 

* Street Address: 

* City: 

* State: 

* Zip/Postal Code: 

* Email Address: 

Husband's Name: 

Husband's Work Phone/Emergency # (XXX-XXX-XXXX): 

If you are flying or riding the rails and need transportation from the airport or train station, please provide details...

Arrival Date (MM/DD/YYYY): 

Arrival Type:  Choose One Car Plane Train Don't know yet

Arrival Airline: 

Arrival Flight Number: 

Arrival Time (HH:MM): 

Connecting City: 

Departure Date (MM/DD/YYYY): 

Departure Type:  Choose One Car Plane Train Don't know yet

Departure Airline: 

Departure Flight Number: 

Departure Time (HH:MM): 

Connecting City: 

Room Preference and Roommate Request
(generally 2 to a room;
a request for 3 may be submitted
In California rooms accomodate 4 per room
in two sets of bunk beds): 

How much experience have you had scrapping?  Choose One None Little Average Too Much!

What is your personal style of scrapping? Choose One Creative Journaling Romantic Simple Cute Bold Heritage

Is there a class you would like to teach, or a technique you would like to share?

* How did you hear about the Blessed Memories Retreats?

Special Dietary Considerations:

Full retreat? Day Cropper? Which meals are you paying for?
Any other comments?:

* How would you prefer to pay?  Choose One Paypal MC/Visa Check/Money Order