REGISTRATION FORM

ASHC-VIETNAM VETERAN’S REUNION

Crowne Plaza St. Louis Airport Hotel

11228 Lone Eagle Dr. Bridgeton, MO

October 21-23, 2011

Name______________________________________________________________

Spouse’s Name______________________________________________________

Address____________________________________________________________

City______________________________State_____________ZIP______________

Telephone____________________Email_________________________________

Unit______________________Dates in country____________________________

Military occupation (Pilot, FE, CE, commo etc)_____________________________

Last rank held or retired rank___________________________________________

Enter amounts below

Reunion registration $40.00 _________________

Dinner $36.00 per person _________________

Total amount due _________________

Make checks payable to ASHC-VVA

Mail this form with your check to ASHC Reunion, c/o Jeff Wojciechowski

40 Tufts Trail, Hopatcong, NJ 07843

For hotel reservations dial (314) 291-6700 ask for “in house reservations” and

mention the Chinook reunion to get the reduced rate of $83 per night.