NAME AS YOU WANT IT TO APPEAR ON YOUR NAME BADGE: _____________________________________________________ YEARS ON BOARD: 19 ______ - 19 ________ RATE/RANK ______________________ SPOUSE AND/OR GUEST NAMES: ______________________________________________________ STREET ADDRESS: __________________________________________________________________ CITY, STATE, ZIP: ____________________________________________________________________ PHONE NUMBER: ____________________________________________________________________ NAME OF EMERGENCY CONTACT: _____________________________________________________ PHONE NUMBER: ____________________________________________________________________ ARRIVAL DATE: _______________________ DEPARTURE DATE: ____________________________ ARE YOU STAYING IN HOTEL? YES ___________________ NO ________________________
ARE YOU FLYING? ______________ DRIVING? __________________ RV? __________________
Listed below are all registration, tour, and meal costs for the reunion. Please enter how many people will be participating in each event and the total amount. Send that amount payable to: USS DeHaven Sailors Association. All registration forms and payments must be received by mail on or before: August 11, 2006.
USS DEHAVEN SAILORS ASSOCIATION
| 2531 N. KINGSDALE RD. | ||||||
|---|---|---|---|---|---|---|
| JOPLIN, MO 64804-1340 | ||||||
| Price per | X | Number of | = | |||
| person | persons | Cost | ||||
| Registration (covers administrative expenses) | $ 10.00 | X | ________ = | |||
| CD of the reunion | $ 10.00 | X | ________ = | |||
| Tuesday Tour | $ 28.00 | X | ________ = | |||
| Thursday Tour | $ 20.00 | X | ________ = | |||
| Friday Night Banquet (Beef or chicken) | $ 30.00 | X | ________ = | |||
| Total | ________ | |||||
Full refunds will be sent for the above mentioned activities if the cancellation is received by August 11, 2006. After that date, refund amount will depend on vendor policies. Please call Jim at 417-624-5718 if you have any further questions. Confirmations will be sent upon receipt of your registration.
Current email address for confirmation: ___________________________________________________