REGISTRATION FORM

DEADLINE: MAY , 2013

Name: Mailing Address: City: Contact Number: ( ) State: Email Address:: Zip Code:

Descendent of (please check one): Willie Jackson Emma Owens Mary Bellenger John Henry Jackson Anne Morgan Joseph Jackson, Jr. Rev. Robert B. Jackson Charity Russell William Jackson Clara Hayes Josephine Russell Not Applicable

No, I will not be coming to the 2013 Jackson Family Reunion. Yes, I will be coming to the 2013 Jackson Family Reunion. The following will be attending the reunion:

Registration fee includes Friday nights Meet and Greet, Saturday nights banquet, Sunday mornings Family Fellowship
PREFERRED NAME FOR NAME BADGE REGISTRATION FEE ADULT ($ ) CHILD ($ ) TODDLER Free
(4 - 12 yrs old) (under 3 yrs old)

LAST NAME

FIRST NAME

TOTAL

1 2 3 4 5 6

$ $ $ $ $ $
TOTAL ATTENDING

TOTAL COST

AMOUNT ENCLOSED $ BALANCE DUE $

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Payment Plans Choose Your Plan Option #1 Option #2 Yes, I would like to make payments towards my total cost Full Payment 2 payments

1st Payment: $_____________ 2nd Payment: _____________ February 2013 May 2013 Option #3 4 payments TOTAL COST Divided By 4 = Monthly Payment: $________________ 1st Payment: 2nd Payment: 3rd Payment: 4th Payment: $_____________ _____________ _____________ _____________ February 2013 March 2013 April 2013 May 3rd, 2013

Once you choose you planYour payments are appreciative as we need to pay

Payment There are two ways to pay the registration fee: 1. By mail: Send your completed registration form along with payment (check or money order only no cash) to 2013 Jackson Family Reunion c/o Cheryl Coy, P. O. Box 90651, Washington, DC 20090. No personal checks accepted after July 1, 2013. Any personal checks that are returned because of insufficient funds will be subject to a $29.00 assessment fee by the bank. 2. Online: Go to www.webjacksonfamilyreunion.weebly.com and click Pay Online and follow the directions to pay using PayPal. You do not have to have a PayPal account to use this service. There will be at a 2.9%+.30 added to the total to cover service fee.

If you have guests who wish to attend the Meet and Greet only, the cost is $15.00 or the Sat. Night banquet only, cost is $50.00 (reservation are needed, so add them to your reservation forms with their money as a guest; and specify if they are attending Friday meet-n-greet only, Saturday banquet only or both).
Please visit our website for updates, additional forms and online payment at http://webjacksonreunion.weebly.com Sorry, no refunds after

For more information, questions, or concerns, please visit our family website at www.webjacksonfamilyreunion.weebly.com or contact Cheryl Coy at (202-250-4977).
________________________________________________________________________________________
For Committee Use Only: Check/Money Order Received: ___________ Amount Recd.: ___________________ Check/MO #: _____________________ Name on Payment: ___________________

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Refunds prior to July 2013, will be charged a 20%administratve fee. No refunds after June 1, 2013.

Registration Fee Includes Payment plan Payment Options

Parts Main Contact Attending? Descendant of Payment Methods

Make all checks/money orders payable to: Chundra McKinney and mail to Chundra McKinney at 808 85th Street South, Birmingham, AL 35206.

Please visit our family website for Family Reunion Updates and to Pay Online! www.baskervillefamilyreunion.myevent.com (Turn Over)
For Committee Use Only Name on payment Payment type Check/MO #: Amount Recd.:

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Registration fee includes Friday nights Meet and Greet, Saturday morning buffet breakfast, Saturday nights banquet, Sunday mornings Family Fellowship PREFERRE REGISTRATION FEE D NAME CHILD TODDLER LAST NAME FIRST NAME TOTAL (4 - 12 yrs (under 3 yrs FOR NAME ADULT old) old) ($ ) BADGE ($ ) Free
1 2 3 4 5 6 7

$ $ $ $ $ $ $
TOTAL ATTENDING TOTAL COST

AMOUNT ENCLOSED $ BALANCE DUE $

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