U.S. NAVCOMMSTA LONDONDERRY Alumni Association "Reunion 2011 in Derry"

REGISTRATION FORM (please print)

Reunion Event Tickets may be ordered on a first come, first serve basis Provide all information so name tags can be
prepared and confirmations sent.

Member Name: _____________________________________________ Nickname (if any): ___________
Rating (or) Civilian: _________ Years in Derry: From: MM/YY ____________ To: MM/YY _____________
Mailing Address: ________________________________________________________________________________
E-mail Address (if any): __________________________________________________________________________
Spouse/Guest Name (include Maiden Name if a “Derry Bride”): ___________________________________________
Names of family members for whom you are purchasing tickets, along with their relationship to you:
Other Guests Names (if any):

Monday, July 25th, Opening Night MEMBERS Reception 

Ticket Price:  Complementary      Number of tickets desired: _____               NO CHARGE

Wednesday, July 27th, GRAND GALA Reception

         Ticket Price:  $20.00 / £13.00 per person      Number of tickets desired: ______            Total Cost: $_______

Sunday, July 31st, MEMBERS Dinner Dance

Ticket Price:  $55.00 / £35.00 per person    Number of tickets desired: _____              Total Cost: $_______ 

Please add the above Total Cost figures to calculate
your TOTAL PAYMENT due at this time:  ---------------------------------- >   TOTAL AMOUNT    $__________


Pay by personal check in U.S. dollars drawn on a U.S. Bank, OR by International Bank Draft in 
U.S. Dollars drawn on a U.S. Bank, OR by International Money Order in U.S. Dollars, OR by cheque in Pound Sterling
all made payable to: 
US Navcommsta Londonderry Alumni Association". 
Mail this form, AND YOUR TOTAL PAYMENT to:

P.O. Box 108
New Boston, MI   48164-0108

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