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Reunion 2007 Registration
First Name *
M.I.
Last Name *
Address *
Apt no.
ZIP *
City *
State/Province *
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington, DC
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Labrador
Manitoba
New Brunswick
Newfoundland
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
Country *
Phone *
E-mail *
I am descended from: *
Thomas of Hampton, NH
Samuel (John of Hingham, MA)
Israel (John of Hingham, MA)
Moses (John of Hingham, MA)
Josiah (John of Hingham, MA)
Nehemiah (John of Hingham, MA)
Not sure
What generation are you?
Number of adults attending reunion
$
$
Names of other adults attending. We are attempting to print as many name tags as possible first--if adult is descended of different line than main registrant, please note.
Number of children 12 & under attending reunion
$
$
Names of children attending--as above, please note line of descent if different than main registrant.
Please make sure to PRINT THIS FORM before submitting it.
Make checks and money orders payable to NALF Inc and mail with registration by June 5, 2007 to:
Richard H Leavitt
23 Beacon Hill Road
Windham, NH 03087
603.434.2251
rleavitt1930@yahoo.com
Any additional questions or suggestions?
* = Input is required
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