Registration Form

Registration

USS Andrew Jackson SSBN 619 Reunion

7-Day Cruise on the Ruby Princess

22-29 January 2012(Sunday to Sunday)

Name___________________________________________________________________

Spouse or other attendee________________________________________________________________

Address: Street/P.O. Box________________________________________________________________

City:__________________________________State:_____________ Zip Code__________________

Phone Number:__________________________ 

Cell Phone Number (Probably one you’ll use while traveling to and from cruise)____________________

Email address___________________________________

Cruise Booking #_____________________ Deck___________________ Cabin #___________________

Please list Hotel and/or any other pertinent information if traveling to Fort Lauderdale before the cruise.

____________________________________________________________________________________

____________________________________________________________________________________

Service Information

Crew:    Blue__________________ Gold_______________ No. Of Patrols_______________

Andrew Jackson service dates: From ______________to __________________

Rank/Rate____________________ Plank Owner: Yes_______ No _______

Other Boats_______________________________________________________________

_________________________________________________________________________

Registration Information

Registration: Cost Per Person: $10.00 

Number coming to Reunion: _________ X $10.00 = $______.00.

Make checks out to Jack McAllister, SSBN 619 Reunion Committee

Mail to: Jack McAllister, 963 Harbor Town Dr., Venice, FL 34292