Registration Form (Make additional copies of form as needed)

Name of person completing form: ______________________________________________________________

Family connection: (daughter or son/daughter-in-law or son-in-law of _______________; sister or brother of _________________; father or mother of _______________________; name of Mol/Mal/Mell/Mull/MeLamp(h)y etc. ancestor, or relative etc.

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Names of Family Members attending for this reservation: Please give first name as it should appear on a nametag. For assistance in booking for caterer, indicate age category of children by writing (5 to 12) or (4 and under) following child's name. There is no charge for children 4 and under, but we do need to give those numbers to the caterer.

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Address: ________________________________________________________________________________

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Telephone: ______________________________________________________________________________

E-mail address: __________________________________________________________________________

Anticipated arrival day and time: ____________________________________________________________

Reservations for Friday evening Dutch Treat dinner

I/we would like to be included in the Dutch treat dinner arrangements for Friday evening dinner.

____________ Adults ___________ Children

_________ Adults at $4 each Subtotal:__________

_________ Children (age 5 to 12) at $2.00 each Subtotal:__________

_________ Children (age 4 and under) No charge

(Please see reverse side)

_________ Adults at $15 each Subtotal:__________

_________ Children (age 5 to 12) at $8 each Subtotal:__________

_________ Children (age 4 and under) No charge

_________ Adults at $6 each Subtotal:__________

_________ Children (age 5 to 12) at $4 each Subtotal:__________

_________ Children (age 4 and under) No charge

________ persons in Double Room(s) at $12.50 per person per night Subtotal:__________

Indicate days with an X: _______ Friday 8/10 ________ Saturday 8/11

________ person(s) in Single Room(s) at $25 per person per night Subtotal:__________

Indicate days with an X: _______ Friday 8/10 ________ Saturday 8/11

(Additional days may be available in the residence halls, if desired. Check with Peggy for availability.)

Make checks payable to Margaret B. Larsen Total enclosed ______________________

_________ I will stay over night in the Hood residence hall accommodations as reserved above for the reunion.

_________ I will stay over night at £ The Holiday Inn Route 40 £ another area accommodation

_________ I will not stay over night for the reunion.

_________ I am unable to attend, but wish to remain on the mailing list for future information.

_________ I would like to receive follow-up information and materials from the reunion and enclose $2 for the

cost of materials and postage.

Please respond by Monday, August 6, 2001 and mail to: Mrs. Peggy Larsen