2010 USS BANG REUNNION
------------------------------Complete form, print and mail to:------------------------------

Mystic Info Center -- Olde Mistick Village -- Mystic, CT -- 06355

FIRST NAME:   LAST NAME:  

ADDRESS:     PHONE:  ()     E-MAIL:  

CITY:   ST:  ZIP:  

NUMBER TAKING THIMBLE ISLANDS CRUISE - 9/28:   012345 678   @ $63 per person.

LUNCHEON CHOICES:  Pork Loin   012345 678   Baked Cod   012345 678

NUMBER TAKING SUB BASE TOUR - 9/29:   012345 678   @ $29 per person.

FULL NAMES AND LAST 4 DIGITS OF SOCIAL SECURITY NUMBER OF
ALL PERSONS TAKING SUB BASE TOUR (9/11 security precautions):

NAME:  SSN(4)  
NAME:  SSN(4)  
NAME:  SSN(4)  
NAME:  SSN(4)  

NUMBER TAKING CASINO TRIP - 9/29 @ 5PM:   012345 678   @ $25 per person.

MAKE CHECK PAYABLE TO Mystic Info Center TOTAL:  $
MUST BE IN BY AUGUST 26th