Class of 1958: Reunion Registration Form - Alumni

Class of 1958: Reunion Registration Form
Register online at www.alumni.cornell.edu/reunion or return this completed form with payment by May 24, 2013 to:
Cornell Class of 1958, Alumni Affairs, P.O. Box 6554, Ithaca, NY 14851-6554
Visit our class website at classof58.alumni.cornell.edu
For Reunion Information: Renni Bertenthal Shuter, Reunion Co-Chair: renni1@charter.net; (314) 863-0220
Meyer Gross, Reunion Co-Chair/Registration Chair: meyeragross@yahoo.com; (212) 223-2588
2013
Classmate Information
First Maiden (if applicable) Last
Please print your name as you would like it to appear on your button; we encourage inclusion of maiden name.
Street address City State Zip Code
Preferred phone Mobile phone (used only during Reunion weekend) Vehicle license plate number (for Reunion weekend)
College E-mail address Cornell Net ID (found on mailing label)
Check here if this is a new address or phone number.
Emergency Information: For use during the Reunion weekend. Must list someone NOT accompanying you to Ithaca.
Emergency contact name Preferred phone Relationship
During Reunion, your picture may be taken by a University Photography staff member and possibly used for future Cornell-related media purposes. If you do not
want your image used, you are responsible for notifying the photographer at the time the photo is taken. University Photography will delete the image on the spot.
I agree to have my name listed on the class/association and university website as attending Reunion. Yes No
This is my_________Cornell Reunion! (first, second, etc.)
If you or your guest have special medical or mobility needs, please contact your registration chair.
Guest Information
Please print your name as you would like it to appear on your button.
Guest If Cornellian: maiden name (if applicable), class, and college Cornell Net ID
Guest If Cornellian: maiden name (if applicable), class, and college Cornell Net ID
Expected Arrival Date/Time
No check-ins before noon Thursday, please.
ARRIVAL DAY: Thurs. Fri. Sat. Time: 9 a.m.–2 p.m. 2–5 p.m. 5–9 p.m. after 9 p.m.
Meals
For special dietary needs, please specify.
# of Kosher ________________ # of Vegetarian______________ # of Gluten-Free_______________ # of Vegan ________________
Friday Night Dinner Selection
# of Salmon________________ # of Roast Beef _______________ # of Vegetarian Ravioli__________

Registration
Please refer to the enclosed information for the various fee options and what is included in each option. Prices are per person.
Adults:
*Early Bird Fee (by 5/10) or Regular Fee (after 5/10)
Full weekend (Thursday–Sunday) # ________ @ $360.00 @ $385.00 = $ __________________
Partial weekend (Friday–Sunday) # ________ @ $295.00 @ $320.00 = $ __________________
Optional:
Class photo # ________ @ $ 25.00 @ $025.00 = $ __________________
Saturday All-Alumni Lunch Extravaganza** # ________ @ $ 17.00 @ $ 17.00 = $ __________________
Thursday Bus Tour 3-4 p.m. (limit 47 people)*** # ________ @ $ 0.00 @ $ 0.00 = $ __________________
Friday Bus Tour 11 a.m.-12 p.m. (limit 47 people)*** # ________ @ $ 0.00 @ $ 0.00 = $ __________________
Friday Johnson Art Museum Tour 11 a.m-12 p.m. (limit 40 people)*** # ________ @ $ 0.00 @ $ 0.00 = $ __________________
* Please note: Early Bird deadlines end at midnight, Eastern Daylight Time.
** All-Alumni Lunch Extravaganza will cost $21 at the door.
*** Tours spaces are filled on a first come, first served basis. You will be notified if your registration form is received after a tour has been filled.
Please contact Meyer Gross if you have special circumstances, meyeragross@yahoo.com; (212) 223-2588.
Housing
TOTAL REGISTRATION FEE: = $ _______________
Alice Cook House has a few double rooms, a handful of suites, and mostly single rooms. There are no private bathrooms. Double rooms will be
provided to couples who note a special need and on a first come, first served basis. If you wish to indicate a preference to room near or with a
specific party, please indicate the name of the person when completing the Housing section of your Reunion registration. The party you request
on your Reunion registration must request you on their form. Requests need to be received by the May 10 early bird registration deadline. This
is not a guarantee of placement with or near the party you request.
The university residence hall charge is $58/adult per night, or save $38 by staying all 3 nights at a total cost of $136/adult.
The Class of 1958 headquarters will be located in Alice Cook House. (Residence halls are non-smoking.)
I/We will be staying on campus. OR I/We will be staying elsewhere. Please indicate where: ___________________________________
I/We would like to room near: ___________________________ Name:_____________________________________________________________
Total number of adults ____________________ × $136.00 for all 3 nights _
OR
Total number of adults ____________________ × Total nights __________ × $58.00 per night
= $ __________________
= $ __________________
___________________________ ____________________ TOTAL HOUSING FEE: = $ ________________
If you have a mobility impairment that requires a special housing assignment (near entrance, first floor, etc.), please explain below. Special
housing assignments can only be made if registration forms are postmarked by 5/24/13.
Special housing need: ______________________________________________________________________________________________________
The Class of 1958 has a limited number of rooms at two hotels for Reunion weekend: Courtyard Marriott (607) 330-1000, and Ramada Inn (607) 257-3100.
Please call direct for reservations, and remember, first come, first served!
Payment
If you are paying with a credit card, please consider using our secure online system to register.
Subtotal for registration (from above)
I have enclosed a check made payable to Cornell Class of 1958. Check # ____________________
I am using my Visa / MasterCard / Discover / American Express (circle one).
Subtotal for housing (from above)
= $__________________
= $ __________________
TOTAL AMOUNT DUE: = $________________
Credit Card Number ___________________________________________________________________ Expiration Date _________________________
Name as it appears on your credit card _________________________________________________________________________________________
Signature/Date ___________________________________________________________________________________________________________
Receipt of your registration will be acknowledged. Until May 24, 2013, all registrations are fully refundable.
Refunds will not be processed until after Reunion weekend.