23rd Union Pre-registration Form

23rd Union – Melungeon Heritage Association
Wytheville, Virginia
June 20, 21, and 22, 2019

PRE-REGISTRATION FORM
(Registration Deadline: June 14, 2019)

The fee is $10 for any or all of the days, Thursday, June 20; Friday, June 21; and Saturday, June 22, 2019. PLEASE EMAIL COMPLETED FORMS TO MHAinc2000@yahoo.com OR SEND TO Melungeon Heritage Association, Inc., PO Box 4063, Barboursville, WV 25504 **For MHA planning purposes, please indicate whether you are attending the Edith Bolling Wilson Tour on Thursday, June 20; the Burke’s Garden Tour and lunch at Your Grate Escape, Friday, June 21; and the reception, Friday evening, June 21.**

(All fees will be payable at the door when you sign in for the 23rd Union at the Bolling Wilson Hotel Lobby or Wytheville Meeting Center)
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Please register below Copy this form for additional registrations.

Will be Attending

Name: _________________________________________________________

Address: _______________________________________________________

Email address___________________________________________________

Check here if you plan to tour the Edith Bolling Wilson Museum at 3 p. m. on Thurs., June 20 ________
Check here if you plan to tour Burke’s Garden & eat at Your Grate Escape on Friday, June 21. _______
Check here if you plan to attend the Friday evening reception, Bolling Wilson Hotel at 7 p. m. _______
\_______________________________________ Email

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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: or complete and email the form as an attachment to mhainc2000@yahoo.com

For any questions please contact: Lynda Davis-Logan at WHATCHANOJOE@hotmail.com or Scott Withrow at MHAinc2000@yahoo.com