1. Healthcare

USS MIDWAY VETERANS ASSN. ACTIVITY REGISTRATION FORM – APRIL 22-26, 2015
Listed below are registration, tour, and meal costs for the reunion. Send the total amount payable to ARMED FORCES REUNIONS, INC. in the
form of check or money order. If a valid email address is provided, a receipt will be sent electronically. Otherwise, your cancelled check will
serve as your confirmation. Returned checks will be charged a $20 fee. You may also register online and pay by credit card at www.afrreg.com/midway2015 (3% will be added to credit card charges). All forms and payments must be received by March 25, 2015. After that
date, reservations will be accepted on a space available basis. We suggest you make a copy of this form before mailing. Please do not staple
or tape your payment to this form. For cancellation policy, refer to program page. Call 757-625-6401 to cancel and obtain a cancellation code.
Armed Forces Reunions, Inc.
322 Madison Mews
Norfolk, VA 23510
ATTN: Midway Veterans
OFFICE USE ONLY
Check # ________ Date Received _________
CUT-OFF DATE IS 3/25/15
Price Per
# of
People
Total
TOURS/OUTINGS
THURSDAY, 4/23: WELCOME DINNER (Please indicate the number of each entrée)
□ TOP SIRLOIN □ COCONUT SHRIMP □ SALMON
$37
$30
$10
$41
$8
$
$
$
$
$
□ TOP SIRLOIN □ CHICKEN BREAST □ GRILLED SALMON □ TOFU
$52
$
MANDATORY PER PERSON REGISTRATION FEE
Includes Hospitality Room and reunion expenses.
OTHER ITEMS
$35
$
FRIDAY, 4/24: TROLLEY TOUR
FRIDAY, 4/24: PADRES STADIUM BEHIND THE SCENES TOUR
FRIDAY, 4/24: PADRES BASEBALL GAME
SATURDAY, 4/25: NAVY SHIP TOUR (fill out additional information below)
BANQUET
SATURDAY, 4/25: BANQUET (Please indicate the number of each entrée)
□ ANNUAL DUES - 2015 $30 □ LIFETIME DUES $150 □ NEW MEMBER
OPTIONAL DONATION TO MVA OPERATING FUND. Write the amount in far right column.
REUNION REGULAR T-SHIRT – Choose color: □ J Navy □ Khaki
Indicate size: □ Medium □ Large □ XL □ 2XL add $1 □ 3XL add $1
REUNION POCKET T-SHIRT – Choose color: □ J Navy □ Khaki
Indicate size: □ Medium □ Large □ XL □ 2XL add $1 □ 3XL add $1
REUNION LADIES T-SHIRT – J Navy only
□ Medium □ Large □ XL □ 2XL add $1 □ 3XL add $1
TOTAL AMOUNT PAYABLE TO ARMED FORCES REUNIONS, Inc.
$15 (M,L,XL)
$16 (2/3XL)
$18 (M,L,XL)
$19 (2/3XL)
$16 (M,L,XL)
$17 (2/3XL)
$
$
$
$
$
$
$
$
$
PLEASE PRINT NAME AS YOU WOULD LIKE IT TO APPEAR ON YOUR NAMETAG
FIRST ______________________________________LAST ____________________________________________
YEARS ON BOARD (EX: 1962-65) __________ DIVISION/SQDN _____________ RATE/RANK _______________
SPOUSE/GUEST NAMES (IF ATTENDING)__________________________________________________________
MEMBER STREET ADDRESS____________________________________________________________________
CITY___________________________ STATE ________________ ZIP____________________________________
PH. NUMBER (________)_________-_________ EMAIL ADDRESS ______________________@_____________
If you paid for Saturday’s ship tour, please fill out additional information for security. Use back of form if more than 4 people.
Full name as shown on Govt ID card
Birth Date (MM/DD/YY)
Home City, State
For questions regarding the reunion, please contact Chairman, Jim Hayter at 703-264-0542 or [email protected].
DISABILITY/DIETARY RESTRICTIONS_____________________________________________________________
(Sleeping room requirements must be conveyed by attendee directly with hotel)
MUST YOU BE LIFTED HYDRAULICALLY ONTO THE BUS WHILE SEATED IN YOUR WHEELCHAIR IN ORDER TO
PARTICIPATE IN BUS TRIPS?  YES  NO (PLEASE NOTE THAT WE CANNOT GUARANTEE AVAILABILITY).
EMERGENCY CONTACT________________________________________ PH. NUMBER (_____)_____-________