Quilts of Valor-Kansas 2011 Retreat

Please fill out the following registration form. At this time, we are unable to electronically submit your registration forms. However, you can fill out the form online, and then copy and paste the page into a blank e-mail addressed to Katy: katy.vickers@att.net. Or print the page and mail it. Registration, with full payment, is due by February 13, 2010. 

Mail the completed registration form, along with your check (made payable to Quilts of Valor), to:
Katy Vickers
12123 Meribeau Ct
Wichita, KS 67235

Registration Information

First Name:
Last Name:
Address Line 1:
Address Line 2:
City: State: Zip:
Phone Number:

I plan to attend:
Full Weekend ($135)
Saturday Only ($37)
Sunday Only ($30)

Emergency Contact Information

Primary Contact Name:
Relationship to you:
Phone Number: Alternate Phone Number:


Secondary Contact Name:
Relationship to you:
Phone Number: Alternate Phone Number:

If there is any additional health information we would need to know in the event of an emergency (i.e. diabetes, medication allergies, etc) please list them here:


If you have any specific dietary needs (i.e. food allergies, or religious observations) please list them here:


Team Work

If you already know who you want to work with in your team of three, please let us know the following information:
Team Member 2 Team Member 3
I will be bringing:
Sewing Equipment/Supplies
Rotary Cutting Supplies
Iron and Ironing Board

I am sending
$35 Deposit only at this time (balance due by Feb 13th)
The full amount
Enclosed is my check for: *Please make your check payable to Quilts of Valor

This year our retreaters (full weekend only)  get a free t-shirt! Please mark your preferred shirt size: Small Medium Large XL 2XL 3XL 4XL

If you are not attending the full weekend, but would still like a retreat t-shirt, please mark your size and include $10 with your retreat registration.

We look forward to seeing you at our third annual Quilts of Valor-Kansas Retreat!


If you have any additional questions, please contact Katy.