Cross Stitch Pals Stitching At The Beach Retreat

October 11-15, 2017

(please print clearly!)

Name __________________________________________________________________

Street/PO Box ___________________________________________________________





E-mail address________________________________________________________________________________

(please make sure your email is written clearly, otherwise you will not receive emails about the retreat. Thank you!)


Phone (_________)_________-_____________


$85 Registration Fee - deadline is August 15, 2017.

**I understand there are absolutely no refunds of the registration fee, that the fee is non-transferable, and that I agree to these terms by signing below.  Failure to sign will void the registration.

Your signature:________________________________________________


Payment is due in full when application is mailed.

Registration will be limited to 100 attendees.


Planned date of arrival ___________________________

We accept check, money order, **Visa, Mastercard, AmExp, Discover and PayPal for registration payment.  **There is an additional $3.00 processing fee added when paying by Credit Card or PayPal.

Circle one - Visa - MC - AmExp - Discover + **$3.00

CC#________________________________________ Exp. date____________ 3 digit code on back of card _________


Signature to allow your card to be charged: _______________________________________________

Please include billing address if different from above:


Mail this form with payment to:
(Checks or money orders must be made payable to Down Sunshine Lane).