U.S. NAVCOMMSTA LONDONDERRY Alumni Association "Reunion 2015 in Derry"

REGISTRATION FORM (please print)

Reunion Event Tickets may be ordered through the Registration Deadline of July 1, 2015. 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):

Sunday, July 26th, Opening Night MEMBERS Reception 

Ticket Price:  $15.00 /(£10.00) per person     Number of tickets desired: ______          Total Cost $ _________

Tuesday, July 28th, GRAND GALA Reception

  Ticket Price:  $20.00 /(£15.00) per person      Number of tickets desired: ______          Total Cost: $__________

Thursday, July 30th, Members Dinner Dance

Ticket Price:  $60.00 /(£40.00) 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
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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