Registration for Starved Rock Day of Weaving 2005 
May 16 

Name: _________________________________________________________

Address: ________________________________________________________

City, State, Zip: __________________________________________________

Phone Number: __________________________________________________

Email: __________________________________________________________

Note: Registration fee is $30 without kit (pattern included).

If you'd like to order a handle, please include $5 for each.

Kit fee is $27 including materials, handle & pattern.

Registration fee ____________________________________ $30

Handle(s) __________________ quantity _____ @ $5 each = ___

Kit fee ____________________ quantity ____ @ $27 each = ___

Total included __________________________________________

Croissant choice (choose one): Chicken Salad, Turkey, Beef, Ham

Send this form and a business sized, self-addressed, stamped envelope to: Debbie Smith, 100 Forest Place #1501, Oak Park, IL 60301

If you have any questions, please contact Debbie at (708) 358-1982 or email her at dasmithrdh@aol.com