October 3-7, 2016

Tampa, Florida

(Please print all information)

Shipmate Name (name on tag)

_______________________________(__________)_____________________________

Years on Board 19_____ to 19_____ Rate_________ Rank__________

Spouse Name (name on tag)

_______________________________(__________)_____________________________

City/Town_________________________________ State_____________

Guest Name (name on tag)

_______________________________(__________)_____________________________

City/Town_________________________________ State_____________

Guest Name (name on tag)

_______________________________(__________)_____________________________

City/Town_________________________________ State_____________

DINNER: BUFFET WITH ALL THE TRIMMINGS

Registration $15.00 X _____ Persons = $________

Dinner Banquet* $28.00 X______Persons = $________

Tour $20.00 X______Persons = $_________ (includes transportation costs & admission)

(American Victory Ship)

Total $________

* Includes gratuity and taxes

{ } Visit to a Casino (by a group or on your own),

Make All Checks or Money Orders Payable To:

USS JOHN R PIERCE DD-753 SAILORS ORG INC.

KARL COX

4610 HOMINY RIDGE ROAD

SPRINGFIELD, OH 45502