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May 4th - 6th 2012 - I {Heart} Scrapbooking Retreat!
Name *
Mailing Address *
Email Address *
Phone # *
Cell Phone
In Case of Emergency Contact *
Birthday *	Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900
Scrapping Level *	Beginner Intermediate Advanced
Names of Friends who will also be attending
A list of attendees will be provided to everyone at the retreat for your convenience. *	Please include me, I love keeping in contact with new scrapbooking friends. No, please do not include me, I already have too many friends.
Specify any special needs
Estimated Time of Arrival *	Between 3-7pm Between 7-10pm, please save me a dinner plate. Between 7-10pm - I will not need a dinner plate. After 10pm
I am using a gift certificate/coupon in the amount of:
Check any that apply	I am a breast cancer survivor. I am living with Multiple Sclerosis. I have an immediate family member with breast cancer. I have an immediate family member with MS.
Check any that apply	If I am among the first four to send in my deposit, I would like a private room with only one bunkbed! I am a Scrap Away Facebook Fan! Please send me text messages about Scrap Away events.
Check any that apply and specify details below*	I would like to donate a door prize for this event. I would like to donate a service for this event. I am a representative for ____ company. I would like to have my business website to be advertised on the Scrap Away Website as a sponsor. I have a personal website, gallery, blog, etc listed below. I would like my personal website to be linked on the new Scrap Away Blog. I heard about Scrap Away from the previous attendee specified below.
*Details for the above, and any other information you wish to share.
I have read and accept all Terms and Conditions. *	Yes