SECOND TO NONE
USMA Class of 1961
40th Reunion Registration Form

Name

(please print name exactly as you want it to read on your name badge)

Wife/Guest Name

(please print name exactly as you want it to read on your name badge)

Address

City

State

Zip

Home Phone #

Work Phone #

E-mail

Registration Fee: $125.00 per classmate

  Credit Card

Name as it appears on credit card

I authorize one hundred twenty-five dollars ($125.00) to be debited from my

  Visa     MasterCard

Account #

Expiration Date

Signature

  Personal Check

Enclosed find a personal check for one hundred twenty-five dollars ($125.00) made out to the “Class of 1961 Admin Fund — 40th Reunion.”

Mail registration form with your personal check or credit card authorization to:

Dick Buckner
15079 Stillfield Place
Centreville, VA 20120-1145

Please send the $125.00 registration fee as soon as possible to provide funds for deposits and other pre-reunion expenses. Thanks in advance . . .