22nd Union Registration Form

22nd Union – Melungeon Heritage Association

Big Stone Gap, Virginia

June 21, 22, 23, 2018

PRE-REGISTRATION FORM

(Registration Deadline: June 14, 2018)

The fee is $10 for any or all of the days, Thursday, June 21; Friday, June 22; and Saturday, June 23, 2018. Please indicate below the days you are attending. **Please see below if you want to have a catered lunch at the Vardy Community Historical Society on Friday, June 22. **

(All fees will be payable at the door when you sign in for the 22nd Union at Mountain Empire Community College)

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Please register each person on a different line. Copy this form for additional registrations.

Will be Attending

Name: ________________________________________ ____ All 3 days ____ Thu. ____ **Fri. ____ Sat.

Address: ______________________________________ Phone (s): Home: _________________ Cell: ___________________

_______________________________________ Email: _________________________________________________

Name: ________________________________________ ____ All 3 days ____ Thu. ____ **Fri. ____ Sat.

Address: ______________________________________ Phone (s): Home: _________________ Cell: ___________________

______________________________________ Email: _________________________________________________

**To request a catered lunch at the Vardy Community on Friday, June 22 contact DruAnna Williams Overbay at druannawilliamsoverbay@gmail.com**

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MHA is a federally recognized 501 (c) 3 non-profit organization. All donations are tax deductible.

I wish to make a contribution to MHA

In Memory/Honor of____________________________________________

Enclosed is my check/money order for $___________

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Thank You for Supporting MHA

Send the completed form for those attending to: MHA, P.O. BOX 3604, MARTINSVILLE, VA 24115 or complete and email the form as an attachment to mhainc2000@yahoo.com

For further information contact Lynda Davis Logan at whatchanojoe@hotmail.com or Scott Withrow at mhainc2000@yahoo.com