Herrick Family Association

Annual Meeting Registration Form

Peabody, Massachusetts

September 17 – September 21, 2008

Name(s):  __________________________________________________________

Address:  __________________________________________________________

City:  ______________________  State:  ____________  Zip:  _______________

Telephone:  (       )________________       Cell Phone:  (         )_______________

                                                                        (In case we need to reach you in Massachusetts)            

E-Mail:  ____________________________ @    ____________________________

Are you registered at the Springhill Suites?                 Yes                  No

                                                                                                                     (Please Circle)

Registration Fee:  (includes meals Friday and Saturday nights)

Registration fee: (Friday night only)

Registration fee:  (Saturday night only)

Make the check payable to Herrick Family Association

Mail the registration form and check to:

                        Sharon Herrick, Treasurer

                        Herrick Family Association

                        3889 Sierra Heights

                        Holt, MI  48842-7706