Registration Form

Please complete this form clearly and print.

One person per form

First name:      Last name:

Address:    Apt:    

City:    State:      Zip Code: 

Email: 

VP#:     

Please pick only one of 3 "dot" selections.

For member 70ers
Registration only ($15.00) 
     (includes: parade hat, group photo, and etc.)

Registration and night banquet on Saturday evening 6 p.m.($50.00)

For non-member 70ers

Registration (free), and night banquet on Saturday evening 6 p.m. ($35.00)

Please return this registration form along with a personal check, cashier’s check or
money order, payable to ‘Class of 70’,
Attn: Frederick Pickering
1114 Morning wood Lane,
Great Falls, Virginia 22066-1609.

No personal checks accepted after October 16, 2010.
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