Registration Form

Must be completed

“Create by the Lake” – Saturday through Monday October 9.10, 11 2010


 

 

Make checks payable to:

Tim McPherson, P.O. Box 368
Midlothian, IL 60445

Call Tim or Jon at (708) 371-8476 for additional info.            
 

 

Name  _______________________________

                 

Address______________________________

____________________________________

____________________________________

        

Phone_____________________________

E-Mail_____________________________

Business name  ___________________________

 

__Enclosed is my deposit of $100.00

__Enclosed is my full payment of $425.00

 

 

I will be rooming with____________________________________

___Please pass my name to someone looking to share room

___Please arrange to purchase additional meals for traveling guests not attending the paint event

 

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