REGISTRATION FORM
NEW ENGLAND REGION EGA SEMINAR -- MAY 2 - 4, 2003 -- FARMINGTON, CT

PLEASE PRINT ALL INFORMATION. Be sure to complete all sections of this form. It is important that you fill out the registration form completely and correctly. If you have any questions regarding this form, please contact the Seminar Registrar Laurie Roys at groys@snet.net.

Name: __________________________
LAST		 _____________________
FIRST and middle initial		 __________________________
Name, to be stitched on your nametag
Address: ____________________________________________________________________________
STREET or PO BOX
____________________________________________________________________________
CITY, STATE, ZIP
Phone:
 		 (______)________________________   Email: ____________________________________
 
Primary Chapter: __________________________   Region: _________________  EGA # ___________
 
Emergency Contact: _____________________________   Phone: (______)_______________________
___This is my first New England Region Seminar           ___I want to be a class "Honey Bee"!
___I need a roommate list, please include my name on the roommate list.   Circle one:  No Smoking
                                                                                                                                   Smoking

CLASS SELECTION
Please indicate 1st, 2nd and 3rd choices. 
1. ___________________________________________  ___________________________________________
   CLASS TITLE                                    TEACHER
 
2. ___________________________________________  ___________________________________________
   CLASS TITLE                                    TEACHER
 
3. ___________________________________________  ___________________________________________
   CLASS TITLE                                    TEACHER

MERCHANDISE

Here is your opportunity to "bee" fashionably accessorized! As a participant, you will be receiving a nametag chatelaine. To go along with your chatelaine, you may purchase a special accessory package which includes the following: a wonderful scissor case, an adorable bee bag, a unique beehive needlecase, a beeswax bee and a pattern for a bee frame weight.

The "bee" accessory package is $18. Order your "bee" accessories for your chatelaine today! "Bee" fashionable at Seminar 2003! To order, be sure to fill out the appropriate line below. See a picture of the accessories packet.
 

REGISTRATION FEES

Price

Total
Non-Refundable Registration Fee

  $25

  $25
Two-Day Class Package (includes ice cream social, lunch for both days, banquet, seminar pin and hand-worked nametag chatelaine)

$150

$150
TOTAL REGISTRATION COSTS

 $175

MERCHANDISE

 Qty. 

Price

Total
"BEE" Accessory Package (includes scissor case, bee bag, beehive needle case, beeswax bee and a pattern for a bee frame weight)  

$18

  
MERCHANDISE TOTAL $

GRAND TOTAL / TOTAL ENCLOSED $

Payment is to be made by check or money order in U.S. funds payable to: NER/EGA SEMINAR 2003

BANQUET DINNER SATURDAY:   ___Grilled Chicken     ___Filet of Sole     ___London Broil

RELEASE FORM

I release The Embroiderers' Guild of America, Inc., the New England Region EGA and the host chapter from any liability for any related financial loss, theft, property damage, or personal injury resulting from registering for or participating in, attending any or all functions at Seminar, and traveling to and from the Seminar. I understand that a cancellation request must be made in writing by April 4, 2003. A refund, less $25, will be made through that date. After April 4, 2003 no refunds will be made. I also certify that I have read the registration, cancellation, and payment information, and agree to the terms and conditions listed therein.

Signature: _________________________________________  Date: ________________
 

MAILING INSTRUCTIONS
Be sure to include the following:

___ Completed Registration Form.
___ Check or money order payable to NER/EGA Seminar 2003 for the total amount due.
___ A #10 business-size SASE for class confirmation.
___ If applicable, a #10 business-size SASE for roommate list.
___ Optional, a self-addressed, stamped postcard for confirmation Registrar has received your registration.

Please photocopy this form for your records.

MAIL TO: NER Seminar Registrar
Laurie Roys
70 Kimball Lane
Torrington, CT 06790-4417		     Phone: (860) 489-0225
Email: groys@snet.net
(please type NER SEMINAR 2003 in the subject line)