Registration Form for Applique by the Bay with Elly Sienkiewicz

Print, Complete and Mail to:

Mare’s Bears Quilt Shop 528 E. Savannah Road Lewes, DE 19958

Name_____________________________________________________________

Address___________________________________________________________

City____________________________State_______________Zip_______

Fax_________________________Phone_________________________________

E-mail______________________________________

Roommate name_____________________________________________________

Registration by mail or phone.  Payment may be made by check, Visa, MasterCard, 
Discover or money order.

Card # ____________________________________  Expiration Date _____________

Day 1 _____	Day 2 & 3 _____	All _____

Fees
December 6, Day 1	$95
December 7 & 8	$145
All 3 Days	$225

Lodging:     # Of Nights________
Single Occupancy_______	Double Occupancy_______
Lodging is at the Beacon Motel which is the building in which we are located:
3 nights $180 or $70 per night