Registration Form

Registration Form

Please complete this form clearly and print.

One person per form

Please pick only one of 2 "dot" selections.

First name: Last name:

Address: Apt:

City: State: Zip Code:

Email: VP#:

Please pick only one of 2 "dot" selections.

For 70ers or non-70ers

$70.00 Combo includes Bash party (Friday night), Football game ticket and Banquet (Saturday evening)

For not attending banquet

You pay yourself at Bash party and/or Football game ticket at the door or not show up

The place of Banquet will be at Kellogg Conference Hotel

Please pick only one of 4 "dot" selections. (click the menu)

Balsamic Glazed Salmon with Jasmine Rice and Steamed Green Beans

Truffle Agave Glazed Chicken with Jasmine Rice and Steamed Green Beans

Filet of Beef with Cabernet Red Wine Sauce, Garlic Yukon Mashed Potatoes and Steamed Green Beans

Stuffed Peppers with Vegetable Quinoa

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 14, 2015.

After you fill out the form, you go ahead to print this page.