------------------------------Complete form, print and mail to:------------------------------

Ralph Gates -- 14 Ridge Circle -- Storrs, CT -- 06268-1612

          YES!, I plan to attend the reunion!

FIRST NAME:   LAST NAME:   YEARS ON BANG:   TO  RATE:  

ADDRESS:     PHONE:  ()     E-MAIL:  

CITY:   ST:  ZIP:   ARRIVAL DATE: DEPARTURE DATE:

PROVIDENCE FLIGHT NUMBER & TIMES:  ARRIVAL:      DEPATURE:  

SPOUSE'S/GUEST'S NAME(S):  

NUMBER ATTENDING BANQUET:   012345 678   @ $45 per person.

DINNER CHOICES:  Beef   012345 678    Chicken    012345 678     Fish   012345 678

HOSPITALITY ROOM STIPEND PER PERSON:       21345 678 @ $10 per person.

Indicate possible interest in van shuttle to Mystic and/or Coast Guard Academy on Thursday after business meeting:  Yes   No Thanks

MAKE CHECK PAYABLE TO RALPH GATES TOTAL:  $
MUST BE IN BY AUGUST 26th