Quilt Camp 2011 Sign Up Form

Please complete the registration below and mail it with $100 nonrefundable deposit to:

Heartbeat Quilts, 765 Main Street, Hyannis, MA 02601
(800) 393-8050 toll free Fax: (508) 790-2711
www.heartbeatquilts.com helen@heartbeatquilts.com

Name:____________________________________________________________ Street:____________________________________________________________ City:___________________________________________ State:_____________ Zip:____________________
Phone: (home)______________________ (work)_________________________ Email:___________________________________________________________

I would like to sign up for:

The 2-night package
□ Single Occupancy ($495/person, all taxes included)
□ Double Occupancy ($395/person, all taxes included)
□ Triple Occupancy ($315/person, all taxes included)

The 3-night package
□ Single Occupancy ($675/person, all taxes included)
□ Double Occupancy ($475/person, all taxes included)
□ Triple Occupancy ($425/person, all taxes included)

□ Rooming with:_____________________________ □ Please assign a roommate

In case of emergency contact:____________________________ Phone:_______________________
Form of Payment: □ Check □ Cash □ MasterCard □ Visa
Account #:______________________________________
Expiration Date:____________________ Signature:________________________________________________________