Registration Form for 2011 USS COLLETT Reunion – Lake Charles, LA
October 5 through 8, 2011 
 
 
Name:     _____________________________________________________ 
 
Address:  _____________________________________________________ 
 
City:     ______________________  State: ___  Zip: ____________ 
 
 
Name for Badge:  ______________________________________________ 
 
     Companion:  ______________________________________________ 
 
        Guests:  ______________________________________________ 
 
List any special dietary needs or other special needs/requests 
 
_______________________________________________________________ 
 
_______________________________________________________________ 
 
 
Thursday (Orleck Tour)		$ 5.00 Number _____	Subtotal _____

Friday (Carriage Ride)		$15.00 Number _____	Subtotal _____

Banquet				$35.00 Number _____	Subtotal _____

Hospitality Room Fee		$15.00 Number _____	Subtotal _____

Unpaid Dues $10.00						Subtotal _____

Future Dues $10.00	Years ___________________	Subtotal _____

									Total    _____

 
Make checks payable to:  USS COLLETT Association 
 
Mail to:

       Sue Senn 
       P.O. Box 742
       Pearce, Arizona 85625 
                  
PLEASE RETURN FORM AND PAYMENT NO LATER THAN 5 SEPTEMBER 2011