USS POLLACK 2012 REUNION


REGISTRATION FORM


Name _____________________________

Address_____________________________

_____________________________

Phone______________________


Guests _____________________

______________________

______________________


Registration Fee $45.00 x’s ______ = _______


Welcome Aboard $20.00 x’s ______ = _______

(Dinner and drinks)


All Day Tour $103.00 x’s ______ = _______

(Includes price of lunch)


Banquet $40.00 x’s ______ = _______


Choice Steak _______ R MR MW WD

Chicken _______


Make checks payable and mail to:

Jack O. Dangerfield

509 W Richardson Ave

Summerville, SC 29483