Name___________________________________________________
Address__________________________________________________
Phone__________________________________
Emergency Name__________________________________
Phone__________________________________
Dietary
problems_________________________________________
ROOMMATE______________________________________________
Circle: Snore: Yes or No Smoke: Yes or No
WEDNESDAY DINNER THROUGH LUNCH ON SUNDAY $253.00
ARRIVAL TIME AFTER 4:00 pm ON WEDNESDAY
THURSDAY DINNER THROUGH LUNCH ON SUNDAY $191.00
FRIDAY DINNER THROUGH LUNCH ON SUNDAY $133.00
DEPOSIT IS $50.00 MAKE CHECKS OUT TO BUSY BEE'S
RETREAT MUST BE PAID IN FULL AT THE SEPTEMBER MEETING.
Date paid________ Amount paid________ check______
cash______
Date Paid________ Amount paid________ check______
cash______
Date Paid________ Amount Paid________ check______
cash______
Date paid________ Amount paid________ check______
cash______
If you have any questions, please call:
MitzyWillbanks or Email: