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: $_______
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
$__________
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, OR by cheque in Pound Sterling 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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