USNA Class of 1959 65th Reunion SignUp	
Name of Classmate/Widow (As it should appear on NAME TAG)	
First and  Last	

Street Address		

Address (cont,)		

City and State		
		
Personal Cell  Phone
Not Home Phone		
USNA Company
(Enter Number)		

Name of Wife/Guests (As it should appear on NAME TAG)	

	

	
Do you have significant mobility issues? Please describe.	
	
Do you have dietary restrictions? Please describe.