Hollingshead Reunion 2003 Registration

Name:

Name of partner/friend attending with you:

Address:

Phone: e-mail:

A few words about yourself or your family branch:

Special needs:

Special diet requirements:

I’m willing to do a 15 minute presentation: [ ] Yes [ ] No

Topic:

I’ll bring a plate of something good from the oven: [ ] Yes [ ] No

I'll bring some shareable material that may be copied: [ ] Yes [ ] No

Nature of material?

I am interested in: Saturday walking tour [ ] picnic [ ]

Registration (US. funds) per person:

$40 to Sept. 30, 2002 $50 Oct 1,2002 to Jan 31,2003 $60 after January 31, 2003

Please take care in calculating your registration – check the date period!

A partner/friend individual registered under the reduced Volunteer Rate (deduct $10) will be expected to assist with administrative duties during the Reunion.

# Primary Registrations @ $__________ = $ ___________________

# Volunteer Registration @ $__________ = $ ___________________

#___________ Bus Tours @ $ 15 = $ ___________________

Total $ ____________________

If you are sending a deposit only check here [____] and send your payment of one-half (1/2) the Total above.

Pledge amount (optional): $

Other Comments:

Please make cheque payable to Anne Klintworth and mail with this form to:

Anne Klintworth

PO Box #72

REGUSA2003 Hinckley, OH, 44233