Charleston UCC Reunion 2010 Reservation Form  *** Please Print ***

Last Name: ________________________ First Name: ____________________ MI: ___

Street Address: ____________________________________________ Apt: __________

City: ________________________________ State: ____ Zip: _____________________

Phone: ________________________ Email: ___________________________________

Retire  Date: ___________ Div: ______________________ Loc: ___________________

Attendees Meal Selections: Please select a meal for each attendee and enter full name of guest(s)

      Retiree ..................................................................Beef ___  Chick___  Fish ___ Veg___
      Spouse ..................................................................Beef ___  Chick ___ Fish ___ Veg___
      Guest(s) ________________________________Beef ___  Chick___  Fish ___ Veg___
      _______________________________________Beef ___  Chick ___  Fish ___ Veg___

Remittance: Total No of Attendees ____ x $25 = Amount _________ Check payable to: Carbide Reunion

Remit To: Carbide Reunion
                 PO Box 8993
                 South Charleston, WV 25303

Optional Interests (Please enter number of attendees interested):

Site Tour ____

Golf Saturday AM - Sleepy Hollow ($45) ____       Golf Contact: Mel Mattison, phone: 304-757-0863, email: mmattison1@aol.com