174th Assault
Helicopter Company
DOLPHINS & SHARKS

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1999 Reunion
October 8, 9, 10, 1999
Ft. Walton Beach, Florida

Registration Form

Pleast print this form, fill it out, and mail with your payment
by SEPTEMBER 15, 1999
to:

Bernie Cobb, Secretary/Treasurer
174th AHC Assn -- Reunion '99
16098 Highway 167
New Brockton, AL 36351

Name:
__________________________

Address:

City: State: _ ZIP:

Phone:
__

FAX and/or E- Mail:

Number attending reunion: _

Arrival date: Departure date:

List number attending Saturday night Fish Fry at $6.00 each (children under 6 free):

T-SHIRTS (Blue only). One shirt free for each paid registrant, extra T-shirts cost $15.00 each.
List Number and Size of T-shirt(s):
____

GOLF SHIRTS:
Golf Shirt Colors are Blue, Black, Red, and Green. Cost is $18.00 each.
List color, quantity, and size:
List color, quantity, and size:
List color, quantity, and size:
List color, quantity, and size:

Names of persons attending with you:

Names of persons to go on Ft. Rucker Museum bus tour:

Names of persons to go on fishing trip (cost not yet determined):

COSTS:

$ Registration fee (number attending X $35.00).
$ Saturday night Fish Fry (number attending X $6.00. Children under 6 free).
$ Extra T-shirts at $15 per shirt.
$ Golf shirts at $18 per shirt.
$ Shipping charge of $3/shirt ONLY for those to be mailed.
$ Dues at $20.00 per year.
$ Donations.

$ TOTAL AMOUNT ENCLOSED (Make checks to "174 AHC Reunion")

For room reservations, call the hotel free at (877) 243-9444 RIGHT AWAY.

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