Registration Form

See also:

Talent Registration

Name:

Address:

City, State, Zip:

Phone:

E-mail:

Family Line/Affiliation:

Saturday Night Dinner:

Saturday Night Drink:

Name or others attending with you: (If child under 4 yrs., add * & If under 12 yrs., add **)

If different household, please fill out separate form.

Name: Sat Dinner: Sat. Drink:

Total Adults #: Total Children #:

Early Registration (Postmarked/E-Mailed By June 15, 2005) Adults $50 Children $40
Late Registration (Received Between June 16 – 30) Adults $60 Children $50

(If reg. by e-mail, money must be sent within 2 days of e-mail or reg. will be invalid)

Total amount Included: $

Please send Checks Or Money Orders Only, made payable to "Shannon Lanier", to…

Shannon Lanier
1020 Grand Concourse
Suite 21L
Bronx, NY 10451

(On the memo line of the check/money order, please write "Hemings Reunion")

Special Needs: (i.e. Wheelchair Access):

Events You will Attend: Refer to Itinerary

Friday night Check-In:		Yes No
Saturday Morning Workout:		Yes No
Saturday at Adena:		Yes No
Bus to Adena from Hotel:		Yes No
Emmitt House Dinner:		Yes No
Bus Tour to Emmitt House:		Yes No
Talent Showcase:		Yes No
Bus to Sunday Church Service:		Yes No
Sunday Church Service:		Yes No
Woodson Cemetery Bus Tour:		Yes No

Emmitt House
Saturday Night Food Selections

#1 Chicken Charly

Served with a Baked Potato, Vegetable of the Day, Salad, Freshly Baked Bread, and Vanilla Ice Cream. for dessert.

#2 Boneless Roast Pork Lion

Served with Mashed Potatoes & Gravy, Applesauce, a Cranberry Glaze, Vegetable of the Day, Salad, Freshly Baked Bread, and Vanilla Ice Cream for dessert.

#3 Vegetarian

Fettuccine Marinara, Vegetable of the Day, Salad, Freshly Baked Bread, and Vanilla Ice Cream. for Dessert.

#4 Kids Menu – Chicken Fingers, French Fries, and Vanilla Ice Cream. for Dessert.

#5 Kids Menu – Hamburgers, French Fries, and Vanilla Ice Cream. for Dessert.

Please Address any Questions or Concerns to:

Shannon Lanier
718-513-3288
HemingsReunion@yahoo.com