Cozy Home Stitches & Retreat Center

Registration Form

Name:_____________________________________

Address:___________________________________

City:______________________________________

State/Zip:__________________________________

Phone:____________________________________

E-Mail:________________________________________________

Date Requested:_______________________________________

Approximate arrival time:_________________________________

To Hold your spot, return this form with a $25.00 deposit

To:       Colleen Jacobson
            105 S. Mantorville Ave
            Kasson, MN  55944