Registration Form for 2^nd RSM Reunion 2010 in Dayton, Ohio

Please fill out and return to:

John Puterbaugh

79 S. Spring St.

West Milton, OH 45383

Phone: 937-698-0763

Email: Folkjohn@aol.com

My name is ______________________________________________________________

Address _________________________________________________________________

City, State, Zip____________________________________________________________          

Email ___________________________________________________________________

Telephone number(s) _______________________________________________________          

( ) Yes, put me down for the Dayton, OH Reunion on April 26^th through April 29^th, 2010.   

There will be ______ people attending, including myself.

The full names of the others attending with me are (required for name tags):

________________________________________________________________________

________________________________________________________________________

              (Please make checks payable to John Puterbaugh)

Enclosed is my reservation fee of $150.00 per person ......................................$_____________

Also enclosed is my contribution for mailing expenses (suggested: $10) ........$_____________

Total amount enclosed ............................................................................................$_____________

All of us plan on attending the following events (sorry, no discount for not attending the events):

(  ) Cocktail party Monday (  ) Cocktail party Tuesday   (  ) Dinner Wednesday   (  ) Group Photo

(  ) Add my name to the volunteer list.  I will be willing to help at the:

(  ) Registration      (  ) Hospitality Suite     (  ) Wherever Needed

(  ) I’m not sure if I can make the reunion, but it sounds enticing!  Keep me on the mailing list.