Name: ___________________________________________________________

Name(s) and relationship(s) of persons attending with you:

_________________________________________________________________

Street Address: ___________________________________________________

City: ____________________________________________________________

State:___________________ ZIP:____________________

Phone and/or FAX: ________________________________________________

E-Mail: __________________________________________________________

Dates served in 174th AHC: ________________________________________

Job description/title/callsign: _______________________________________

TOTAL NUMBER OF T-SHIRTS AND SIZES (one free per paid registrant):

S: _______ M: _______ L: _______ XL: _______ XXL: _______ XXXL: ______

COSTS:

$ ___________ Cost of extra T-shirts
($14 each plus $3 for one or $5 for two or more if mailed)
$ ___________ Registration Fee ($35 each attendee)

$ ___________ Saturday Night Buffet ($17.50 each attendee)

$ ___________ Year 2003 DUES ($20.00 per year)

$ ___________ Donations (Applied to administrative expenses)


$ =========== GRAND TOTAL DUE

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NAME(S) OF PERSON(S) TO GO:

FISHING: ____________________________________________________

GOLFING: ___________________________________________________

BAY CRUISE: ________________________________________________

ZOO TOUR: __________________________________________________

For Room Reservations, call toll-free: 1-877-243-9444
Or FAX: 850-243-5445
Or E-Mail: bwbeach@bw.gccoxmail.com

MAKE YOUR ROOM RESERVATIONS BY SEPTEMBER 13th

Make checks payable to "174th AHC Assn."

MAIL FORM AND CHECK TO:

Bernie Cobb
Secretary/Treasurer
174th AHC Association
16098 Highway 167
New Brockton, AL 36351