Please register me for the following  2018 "Simply A Scrappin Escape" retreats:

 Registration Form – Please circle applicable weekend(s) you will attend.

February 16, 17, 18, $85.00 Early registration closes January 5, 2018, $95.00 after 1/5/18

April 20, 21, 22,   $85.00 Early registration closes March 1, $95.00 after 3/1/18

July 27, 28, 29, $100.00 – Early registration closes June 1, $110.00 after 6/1/18

September 21, 22, 23, $85.00 Early Registration closes August 1, $95.00 after 8/1/18

November 16, 17, 18, $85.00 Early Registration closes Oct. 1, $95.00 after 10/1/18

Name _______________________________________

Email _______________________________________

Phone _______________________________________

T-Shirt Size (July only) _______Small ______Medium _______Large _______Extra Large

ADD $5.00 for T-Shirts sizes _____________1 – X __________2 – X __________3 –X

Weekend Registration $  _______________

Food Allergies___________________Food Restrictions _________________________

Please seat me with my friend(s) who are also attending ____________________

____________________________________________________________________

PLEASE NOTE: No Cash Refunds unless the event is cancelled.  There is a $35.00 fee for any checks returned by your bank. Cancellation policy:  30 days prior to the event you may move your reservation to the next scheduled event.  Only one move is allowed.  21 days prior to the event NO MOVES will be allowed and monies will be forfeited.  Cancellations must be received in writing either by email or by mail.  The date we receive the request is the cancellation date that will be used.  I have read the refund and cancellation police and agree to the terms. _________________(Initials)

RELEASE AND HOLD HARMLESS AGREEMENT

I, ________________________________________________, have the opportunity to participate in a “Simply A Scrappin Escape” retreat beginning on _______________20___ and ending on ____________________20__________ at the Hampton Inn, 2423 Bushwood Drive, Aurora, IL 60506.

I, the undersigned, am aware of the possibility of injuries or accidents while on this retreat.

In consideration being allowed to participate in the scrapbook retreat, I agree to assume full responsibility for my safety and medical treatment while participating in the retreat.  I agree to release, indemnify, and hold harmless Janice E. DuRall/Scrap 'N Dream/Simply A Scrappin Escape, and all members of her family from any and all liability for personal injury including death or for damage to property that may occur to me or to others as a result of my participation in the scrapbook retreat.  The terms hereof shall also serve as a release, forever discharge, indemnify and hold harmless Janice DuRall, Scrap ‘N Dream and Simply A Scrappin Escape from any and all claims, demands or causes of action of any type or nature, which are in any way connected with my participation and an assumption of risk for my heirs, executor, and administrator and for all members of my family and may be pleaded as a bar to litigation.

Jurisdiction of this matter and venue shall lie in Aurora, Kane County, Illinois.

I also give permission for photos, which my include me, to be used on websites and other internet sites without payment or reimbursement.

I have read the Release and Hold Harmless Agreement and understand and voluntarily accept its terms.

____________________________Signature

______________________ Date

PAYMENT MUST BE MADE IN FULL AT THE TIME OF REGISTRATION. PLEASE MAKE YOUR CHECK PAYABLE TO Jan DuRall and mail with signed registration form to 1091 Monticello Drive, Aurora, IL 60506

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For further information please visit our website www.scrapndream.com or email Jan at scrapndream@ att.net or call 630-862-4401.