JACKSON BRIGADE 2004 REUNION

RESERVATION FORM

Reservations and payment must be received by June 30, 2004

Make checks payable to "Jackson Brigade, Inc. "

and mail to Ann Fissel / RR2 Box 335 / Cairo, WV 26337

Name ________________________________________________________________________

Phone _____________________________ E-mail ____________________________________

Address ______________________________________________________________________

City ______________________________ State _____________ ZIP _____________________

Please provide names of those in your party and from which Jackson-Cummins line each descends (e.g., George line, Sophia line, etc.) For children, please also include ages of each. ______________________________________________________________________________

_________________________________________________________________________________________________________________________________

Breakfast and Lecture – Saturday, August 7, 2004
	Price	x Number attending	Cost
Adults	$0.00 each		$0.00
Children 10 and under	$0.00 each		$0.00
SUBTOTAL A			$0.00

Parkersburg Tour – Saturday, August 7, 2004
	Price	x Number attending	Cost
Adults	$0.00 each		$0.00
Children 10 and under	$0.00 each		$0.00
SUBTOTAL B			$0.00

Banquet – Saturday, August 7, 2004
	Price	x Number attending	Cost
Adults	$9.00 each		$
Children 10 and under	$6.00 each		$
SUBTOTAL C			$

Picnic – Sunday, August 8, 2004
	Price	x Number attending	Cost
Adults	$4.00 each		$
Children 10 and under	$3.00 each		$
SUBTOTAL D			$
TOTAL (ADD SUBTOTALS A-D)			$