Name: ___________________________________________________________
Name(s) and relationship(s) of persons attending with you:
_________________________________________________________________
Street Address: ___________________________________________________
City: ____________________________________________________________
State:___________________ ZIP:____________________
Phone and/or FAX: ________________________________________________
E-Mail: __________________________________________________________
Dates served in 174th AHC: ________________________________________
Job description/title/callsign: _______________________________________
TOTAL NUMBER OF T-SHIRTS AND SIZES (one free per paid registrant):
S: _______ M: _______ L: _______ XL: _______ XXL: _______ XXXL: ______
COSTS:
$ ___________ Cost of extra T-shirts
($14 each plus $3 for one or $5 for two or more if mailed)
$ ___________ Registration Fee ($35 each attendee)
$ ___________ Saturday Night Buffet ($17.50 each attendee)
$ ___________ Year 2003 DUES ($20.00 per year)
$ ___________ Donations (Applied to administrative expenses)
$ =========== GRAND TOTAL DUE
NAME(S) OF PERSON(S) TO GO:
FISHING: ____________________________________________________
GOLFING: ___________________________________________________
BAY CRUISE: ________________________________________________
ZOO TOUR: __________________________________________________
For Room Reservations, call toll-free: 1-877-243-9444
Or FAX: 850-243-5445
Or E-Mail:
bwbeach@bw.gccoxmail.com
MAKE YOUR ROOM RESERVATIONS BY SEPTEMBER 13th
Make checks payable to "174th AHC Assn."
MAIL FORM AND CHECK TO:
Bernie Cobb
Secretary/Treasurer
174th AHC Association
16098 Highway 167
New Brockton, AL 36351