REGISTRATION, DAYTON OHIO REUNION

Please send this completed form with a check or money order payable to : “Blackhawk Association” and mail to: Richie Kloepfer, 2 Manderley Ln., Ormond Beach, Florida 32174. Any questions, please feel free to call 386-615-0635.

All registration forms and payments must be received on or before Sept. 30th, 2004

It is imperative and very much appreciated that you send in your registration and make your hotel reservations ASAP to avoid last minute chaos.

                                 #Of Attendees      Amount
Registration fee:    $25.00 X ______ = ______
(Covers beer, soda and snacks in hospitality room.)

Friday bus transportation to and from Museum: $5.00 X______ = ______
Saturday afternoon bus ticket:                               $5.00 X______ =______
Saturday Evening Banquet Dinner:                     $55.00 X ______ =______
Sunday Brunch at Hotel:                                       $14.00 X_______ =______

                                                                     Total Check Amount __________

Name (for name tag) ______________________________________________

Troop: ______ Years served (ie.1966-1969)__________________

Spouse and or Guest Names: _______________________________________

Street Address______________________ City, State, Zip:__________

Phone Number______________________Email____________________________

Disability or Dietary:__________________Emergency Contact_____________
Phone
Number:______________________ Arrival Date:_______________________

Departure Date:_______________________

Are you staying at the Dayton Marriott Hotel?                  Yes_____ No_____
Playing in the first annual Blackhawk Golf Tournament?  Yes_____ No_____

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