USS Willard Keith DD-775 Reunion registration Form
Name (for name badge) __________________________________________________________
Spouse/Guest (for name badge) ___________________________________________________
Address_______________________________ City _________________________ State ______
Phone# ______________________ E-mail ____________________________________________
Emergency contact: Name: ______________________________________________________
Phone: _______________________________
Dietary restrictions______________________________________________________________
Confined to wheelchair__________________________________________________________
***************************************************************************************************************
Reunion Activities Package:
Number of attendees: ________ X per person = Total _________________.
Banquet Meal Choice:
#______ #_______ #_______
A deposit is requested by with final payment due . No refunds on activity package after .
Mail Registration Form with your check payable to:
Keith Crewmen must have current membership ($25.00) to attend the reunion.
Mail dues to:
Paul Goldberg
1549 Sprayberry Drive
Marietta, GA 30066
