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Hampton Roads Chapter of VAD

Christmas Party
Registration Form
Holiday Inn Oceanfront
2012 Atlantic Ave
Virginia Beach VA

December 8, 2012 (Saturday)


Name:________________________________________________________________________
Address:______________________________________________________________________
City/State/Zip Code:____________________________________________________________

~Please mail your registration form BEFORE November 28, 2012~


Special Diet: (Check all that apply)
_____ Vegetarian
_____ Food Allergies____________________
_____Other: Please specify need:___________

Adult: $25 x ____ = _____


Child (age 3-11): $11 x ____ = _____
Total:

_____

Please make check or money order payable to: HRCVAD and send to Daniel Creech, Treasurer,
P.O. Box 7225, Hampton VA 23666