11thACVVC REUNION XXI KANSAS CITY, MO.
THURSDAY, SEPTEMBER 21, THRU SUNDAY, SEPTEMBER 24, 2006

Registration fee is $68.00 per person. This fee is required for attendance at any of the scheduled program events including Thursday and Friday Bunker Parties and Saturday Banquet dinner. The registration fee will be an additional $10.00 to the above price for registrations received after AUGUST 27. 2006  

PLEASE PRINT ALL INFORMATION AND REGISTER EARLY

NAME_____________________________________TELEPHONE NO._________________________

ADDRESS___________________________________________________________________________

CITY/STATE/ZIP_____________________________________________________________________

Telephone Number____________________________ EMAIL ADDRESS________________________

Please list only one Troop Or Company (i.e. B troop 66/67 or H Co 69-70)

UNIT ASSIGNMENT__________________________ YEARS IN COUNTRY___________________ 

Attendees
_____________________________________________  $_____________
_____________________________________________  $_____________
_____________________________________________  $_____________
_____________________________________________  $_____________

Banquet Meal Selection (Choose one per Banquet Attendee)

CHICKEN___________________ BEEF___________________ VEGGIE_______________        

Special Dietary Needs YES/NO, If yes please indicate needs
Wheelchair required   YES/NO      FIRST REUNION YES/NO

Send Check or Money Order (no cash please) for the full amount, payable to 11ACVVC REUNION XXI or complete information below for Visa or Master Card.

Check One   ______VISA _______MASTER CARD

Credit Card Number_______________________________

Expiration Date Mo_______ Yr_________________

Signature___________________________________________ (Required)

Mail to   11 ACVVC Reunion XXI
c/o Ollie Pickral
      571 Ditchley Rd.
      Kilmarnock, Va  22482