2012 Members Retreat Registration « American Tapestry Alliance

Name*

FirstLast

Address*

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Phone*

Cell Phone

Email*

Roommate's name

*Teacher Preference (number in order):

Either Instructor*

Please enter a value between 1 and 3.

Brennan*

Please enter a value between 1 and 3.

Larochette*

Please enter a value between 1 and 3.

*Teacher preferences will be assigned according to date of registration.

Emergency Contact Name*

Emergency Contact Phone Number*

Dinner choice for the Saturday night banquet*

Pan Seared Chicken
Grilled Vegetable Stack

Pan Seared Chicken: Chicken Breast with Fresh Spinach and Mushrooms served with a Shitake leek Compote Grilled Vegetable Stack: Layers of organic Eggplant, Zucchini, Yellow Squash and Provolone in Pesto Sauce with oven roasted Organic Potatoes

Registration

Enrollment is limited. Early bird registration must be received by April 15, 2012. Registration closes May 31, 2012. Retreat fees for non-ATA members include a one-year membership to ATA. Full refunds, less a $50.00 administrative fee are granted until May 31, 2012. No refunds will be granted after that date. Checks returned for insufficient funds will be assessed a $25.00 fee. Questions? Contact Erika Scott: email hidden; JavaScript is required

Fees

Price: $0.00

Are you an ATA Member?*

Yes
No

Registration Fee*

Early Bird (Ends April 15, 2012)
Late Registration (Ends May 31, 2012)

Registration Fee*

Early Bird (Ends April 15, 2012)
Late Registration (Ends May 31, 2012)

Room and Board*

Single Room: Saturday pm - Tuesday am
Double Room: Saturday pm - Tuesday am
Single Room: Saturday pm - Wednesday am
Double Room: Saturday pm - Wednesday am
I will be staying off campus.

Transportation from the Long Beach Convention Center to Chapman College

Yes, I would like transportation to Chapman College
I will provide my own transportation to Chapman College

Total

$0.00

Payment Method*

We strongly encourage you to pay with your credit card directly through the PayPal portal. You do not need a PayPal account to use this service. It will ensure your reservation is received as quickly as possible. If you prefer to mail in a check, please download a Payment Form, fill out completely, and mail to:
fill out completely, and mail to:
Marcia Ellis 5565 Idlewood Rd. Santa Rosa, CA 95404 USA

We strongly encourage you to pay with your credit card directly through the PayPal portal. You do not need a PayPal account to use this service. It will ensure your reservation is received as quickly as possible. If you prefer to mail in your credit card information, please download a Payment Form, fill out completely, and mail to:
Marcia Ellis 5565 Idlewood Rd. Santa Rosa, CA 95404 USA

Please include the following note with your PayPal payment: 2012 Members Retreat Registration Payment

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