Quilters  Paradise  Retreat  –  Quilting  at  the  Beach  Hosted  by  Quilting  by  the  Bay  

January  23-­‐25,  2015  Retreat  Registration  Form    

Name:  _________________________________________    Email  address:  ______________________________________  

Address:  _________________________________________________    Phone  number:  ___________________________    City:  __________________________________      State:  ____________    ZIP:  ___________________    Emergency  Contact  _______________________________  Phone  _______________________    Accommodations  -­‐  Please  check  one:                                        Double  Occupancy  ($325)     Triple/Quad  Occupancy  ($300)  –  you  must  arrange  your  own  roommates                                  

Single  Occupancy  ($400)               No  Accomodations  Required  ($250)      

Name  of  Roommate/Roommates:  _____________________________________________________    Payment  Information  A  minimum  deposit  of  $100  is  required  to  confirm  registration.  Your  balance  due/final  payment  will  be  automatically  charged  to  your  credit  card  on  file  between  the  1st  and  10th  of  November  2014.    Your  signature  below  is  an  acknowledgement  that  you  have  read,  understand  and  agree  to  all  terms  and  conditions  of  registering  contained  in  this  registration  form.    The  undersigned  agrees  to  indemnify  and  hold  Quilting  by  the  Bay  harmless  for  any  loss,  damage,  injury  and/or  other  harm  sustained  during  our  retreat  events.    Further,  you  agree  to  make  no  claim  against  Quilting  by  the  Bay,  its  owners,  officers,  employees,  contractors,  agents,  or  volunteers  for  any  loss,  damage,  injury,  and/or  other  harm  sustained  during  our  retreats.    CANCELLATION/CHANGE  POLICY  If  you  are  unable  to  attend  the  Retreat  and  you  must  cancel  your  registration  entirely,  Quilting  by  the  Bay  will  charge  a  cancellation  fee.  Cancellation  policies  apply  to  all  students.  Cancellation  notices  must  be  emailed  to  registration@quiltersparadiseretreats.com  faxed  to  (850)215-­‐7283  or  mailed  to:    Quilting  by  the  Bay,  2303  Winona  Drive,  Panama  City,  FL  32405  All  cancelled  reservations  will  have  the  following  charges:      -­‐    Postmarked/emailed  on  or  before  November  1,  2014  -­‐  $25  cancellation  fee    -­‐    Postmarked/emailed  between  November  1,  2014  –  January  5,  2015  -­‐  $50  cancellation  fee      -­‐  Postmarked/emailed  on  or  after  January  6,  2015  –  No  refund    Your  registration  is  fully  transferrable  to  another  student  at  any  time  with  advance      Signature:  _____________________________________        Date:  __________________      Payment  by  Credit  Card  (Visa/MasterCard/Discover  only)    -­‐  Only  include  your  credit  card  information  if  you  are  not  making  an  online  payment.    Deposit  Amount  $  __________    Credit  Card  #  _______________________________________    Card  Expiration  Date  ______________        3  digit  CVV  _________  Name  on  Card  ______________________________________  Billing  address  if  different  from  mailing  address  ___________________________________________________________________      

We  do  not  accept  registrations  by  phone.    Incomplete  registration  forms  will  delay  your  class  confirmation.  

I  have  read,  understand,  and  agree  to  the  Quilters  Paradise  Retreat  Cancellation  and  Change  Policy.    Initial  Here:  ____________