2010 Retreat March 18 - 21, Dayspring Conference Center

Room and Board Reservation FORM
(SCROLL DOWN FOR CLASS REGISTRATION FORM)

Registration 1 day - No Meals - ----------------------------------------$40.00 Meals - Breakfast $10.00, lunch $13.00, Dinner -------------------$15.00 Registration Fee – 1 Night, 2 Days------------------------------------$150.00* Registration Fee – 2 Nights, 3 Days – Friday thru Sunday -----$275.00* Registration Fee – 3 Nights, 4 Days – Thursday thru Sunday--$325.00* *These fees includes all meals, snacks and room.

Reservation for room and board may be paid in installments with full payment due February 1, 2010. There is a$25.00 cancellation fee before February 1, 2010. No cancellations or refunds after February 1, 2010.

Please make checks payable to SSDA and mail to Julie Danke, Treasurer, 5219 18th Ave E., Bradenton, FL 34208 Email dankedoodles@aol.com Telephone 941-747-0055

If you have questions, please contact Julie Danke (left) or Ann Roberts at 813-986-3865 or email marob579@verizon.net.

 SSDA RETREAT ROOM & BOARD RESERVATION:

Name
Address
City	State	Zip
Chapter Affiliation(s)
Phone	Cell Phone
Email
If you would like a specific roommate and/or cabin mates, please list:
Please list your special needs (diet, handicap, allergies, etc.)
Do you have difficulty with stairs?	Any Special Needs

GOLF CART TRANSPORT SERVICES are available to take you from class to class if you make pick up
arrangements ahead of time with the Dayspring Office.

> EMERGENCY CONTACT - REQUIRED INFORMATION <

Name	Phone
Relationship	Cell Phone

> EMERGENCY CONTACT - REQUIRED INFORMATION <

Name	Phone
Relationship	Cell Phone

SSDA CLASS REGISTRATION FORM

Please follow the instructions carefully. Photo copy this sheet so that you can fill out one class registration form for each class.
Please print legibly. Write a separate check for the TOTAL AMOUNT for each class and make it payable to the teacher.
Mail class registration forms and checks to
Michelle Shroyer, 706 Belt Court, Tampa, FL 33612-5717
Phone: 813-971-5010 Email: tampashroyer@aol.com

Name
Address
City	State	Day Phone
Zip		Evening Phone
Class Name and #
Day and Time
Teacher’s Name
Class Cost $		Supplies $	TOTAL $

Name
Address
City	State	Day Phone
Zip		Evening Phone
Class Name and #
Day and Time
Teacher’s Name
Class Cost $		Supplies $	TOTAL $

Name
Address
City	State	Day Phone
Zip		Evening Phone
Class Name and #
Day and Time
Teacher’s Name
Class Cost $		Supplies $	TOTAL $