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: $__________
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 $__________
METHOD
OF PAYMENT
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:
USNLAA
P.O. Box 108
New Boston, MI 48164-0108
USA
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