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2009 George Wells Family Reunion

REGISTRATION FORM

JULY 17 19, 2009

DoubleTree Hotel Chattanooga

407 Chestnut Street

Chattanooga, TN. 37402

(423) 752-6977

 

Return form with registration fee by January 30, 2009 or April 17, 2009 to:

Stanley Chalk

20 Battlefield Ln

Ringgold, GA. 30736

 

 

Last Name: ____________________________________ First Name: ________________________________________

Address: _________________________________________________________________________________________

City: ____________________________________________ State: ______________ Zip: ________________

Phone: ___________________________ email: ________________________________________________________

 

Half registration fee by January 30, 2009 2nd half by April 17, 2009:

# Adults (12 years and older): _______ X $ 47.50 = $________ # Children Under 12:_______ X $ 20.00 = _______

 

Full registration fee by January 30, 2009 or April 17, 2009:

# Adults (12 years and older): _______ X $ 95.00 = $_________ # Children Under 12:_______ X $ 40.00 = _______

 

T-SHIRTS

$15.00 Adult $10.00 Child

Small ____ Small ____

Medium____ Medium ____

Large____ Large ____

1X ____

2X ____

3X ____

4X ____ TOTAL T-SHIRTS $________

 

 

TOTAL ENCLOSED $____________ Make checks payable to Wells Family Reunion