Registration Form

USAF Hospital Clark
The Philippine Islands
Reunion
_______________________________________________

26-28 October 2007

Please Print:


Last name, First name Middle initial Nickname (at Clark AB)


Name Badge – Please print how you would like your name to appear


Name - Significant other Name Badge – Format


Address City State Zip Code


E-Mail Address


Rank (at Clark AB) DOS/DOR (Date of Separation/Retirement) Rank


Unit at Clark AB Duty Section(s)

Registration Fee: $160.00 per person Number attending: _____________
$175.00 (1-10 October)

TOTAL: _______________________ Signature: ______________________________

Make check(s) payable to: USAF Hospital Clark Reunion

Send your Registration Form and your Remittance to:

USAF Hospital Clark Reunion
C/o Captain Donna L. de Wildt
107 Market Street, Suite One
Portsmouth, New Hampshire 03801

If you have questions, please contact CMSgt. Bonnie Cooper, Tel: 210.520.5580, or Captain D.L. de Wildt, Tel: 603.433.1163 / 603.512.9324 / DMATICS@Aol.com.
Assistance Needed at the Reunion:

If you would like to help out at the reunion, the following tasks need filled. Please place a check mark in the pertinent box:

? Friday, 26 October, 1400 – 1530 Registration /Hospitality Suite Monitor
? 1530 – 1700
? 1700 – 1830
? 1830 – 2000

? Friday, 26 October, 1400 – 1530 Terminal D Greeter/Guide
? 1530 – 1700
? 1700 – 1830
? 1830 – 2000

? Saturday, 27 October, 0700 – 0830 Registration/Hospitality Suite Monitor
? 0830 – 1000
? 1000 – 1130
? 1130 – 1300
? 1600 – 1730