Registration Form Revised

Registration Form Port Kirwan Come Home Year 2010 "This is our Home" th August 5 – August 9th th

Complete this form and mail with payment to address below before June 30 , 2009 or If you are NOT attending, sign and return form to committee and your name will be removed from our mailing list. st

(*Registration Reminders will be sent out @ June 1 , 2009) Price of Registration package includes Souvenir printed T-Shirts, Program booklet, Personalized name tags and a Small keepsake of “Port Kirwan Come Home Year 2010”. REGISTRATION FEES: Adults (19 up) - $20.00 Youth (13 – 18) - $10.00 Children (3 - 12) - $5.00 Infants (2 and Under) - Free (Please print all names clearly for name tags. Feel free to use the back of the sheets for extra information.)

Your Name: _____________________________________________________________________________ Full Mailing Address: ______________________________________________________________________ ______________________________________________________________________ Will you be attending “Port Kirwan Come Home Year 2010”

Phone: (

) ____________________

# Attending in family ________

□ YES

□ NO

Email Address: ______________________________________

*Would you or any others in your family be interested in volunteering Yes______

No______

List names of others in your family that will be attending, and relationship (spouse, partner, daughter, son, guest, etc.): 1.______________________________________________________________________ 2.______________________________________________________________________ 3.______________________________________________________________________ 4.______________________________________________________________________ 5.______________________________________________________________________ (If you have children please list their ages.) * Please use back of sheet to list any extra family or volunteering information.

Registration

#

Cost

Infants 2 and under

Free

Children 3 - 12

$5.00

Youth 13 - 18

$10.00

Adult - 19 and up

$20.00

Total Cost for Family *Cost of Extra T Shirts (If Any) Total Amount Enclosed

Sub Total

T Shirt Size

Quantity

YOUTH CHILD 2 -4 (SM) Youth 6 – 8 (MD) Youth 10 – 12 (LG) Youth 14 – 16 (XL) Youth 18 – 20 ADULT ADULT Small ADULT Medium ADULT Large ADULT X Large ADULT PLUS ADULT XX Large ADULT XXX Large $ $ $

One T Shirt is included with each registration package but extra T Shirts can be ordered at extra cost. Prices for ordering Extra T Shirts: Youth Sizes - $8.00 Adult - $12.00 Adult Plus - $14.00 Check the sizes above and just add in the cost in the space provided* on the form. Please use the back of sheet if you feel you need to add a note.

Mail completed form with money order to:

Port Kirwan Come Home Year 2010 "This is our Home" Site 2, P.O. Box 30 Port Kirwan, NL A0A 2G0

Please feel free to contact any member of the “Come Home Year” Committee If you have any questions or concerns: Carol Ann O'Neill : (709) 363-2525 , Gerald O'Neill : (709) 363-2525, Vianne Chidley : (709) 363-2516 Kristina Fennelly : (709) 363-7530, Gen Kenny: (709) 363-2842 E Mail Address: [email protected] Web Site: http://www.freewebs.com/port-kirwan/