Class of 1958: Reunion Registration Form - Alumni
Class of 1958: Reunion Registration Form - Alumni
Class of 1958: Reunion Registration Form - Alumni
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<strong>Class</strong> <strong>of</strong> <strong>1958</strong>: <strong>Reunion</strong> <strong>Registration</strong> <strong>Form</strong><br />
Register online at www.alumni.cornell.edu/reunion or return this completed form with payment by May 24, 2013 to:<br />
Cornell <strong>Class</strong> <strong>of</strong> <strong>1958</strong>, <strong>Alumni</strong> Affairs, P.O. Box 6554, Ithaca, NY 14851-6554<br />
Visit our class website at class<strong>of</strong>58.alumni.cornell.edu<br />
For <strong>Reunion</strong> Information: Renni Bertenthal Shuter, <strong>Reunion</strong> Co-Chair: renni1@charter.net; (314) 863-0220<br />
Meyer Gross, <strong>Reunion</strong> Co-Chair/<strong>Registration</strong> Chair: meyeragross@yahoo.com; (212) 223-2588<br />
2013<br />
<strong>Class</strong>mate Information<br />
First Maiden (if applicable) Last<br />
Please print your name as you would like it to appear on your button; we encourage inclusion <strong>of</strong> maiden name.<br />
Street address City State Zip Code<br />
Preferred phone Mobile phone (used only during <strong>Reunion</strong> weekend) Vehicle license plate number (for <strong>Reunion</strong> weekend)<br />
College E-mail address Cornell Net ID (found on mailing label)<br />
Check here if this is a new address or phone number.<br />
Emergency Information: For use during the <strong>Reunion</strong> weekend. Must list someone NOT accompanying you to Ithaca.<br />
Emergency contact name Preferred phone Relationship<br />
During <strong>Reunion</strong>, your picture may be taken by a University Photography staff member and possibly used for future Cornell-related media purposes. If you do not<br />
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.<br />
I agree to have my name listed on the class/association and university website as attending <strong>Reunion</strong>. Yes No<br />
This is my_________Cornell <strong>Reunion</strong>! (first, second, etc.)<br />
If you or your guest have special medical or mobility needs, please contact your registration chair.<br />
Guest Information<br />
Please print your name as you would like it to appear on your button.<br />
Guest If Cornellian: maiden name (if applicable), class, and college Cornell Net ID<br />
Guest If Cornellian: maiden name (if applicable), class, and college Cornell Net ID<br />
Expected Arrival Date/Time<br />
No check-ins before noon Thursday, please.<br />
ARRIVAL DAY: Thurs. Fri. Sat. Time: 9 a.m.–2 p.m. 2–5 p.m. 5–9 p.m. after 9 p.m.<br />
Meals<br />
For special dietary needs, please specify.<br />
# <strong>of</strong> Kosher ________________ # <strong>of</strong> Vegetarian______________ # <strong>of</strong> Gluten-Free_______________ # <strong>of</strong> Vegan ________________<br />
Friday Night Dinner Selection<br />
# <strong>of</strong> Salmon________________ # <strong>of</strong> Roast Beef _______________ # <strong>of</strong> Vegetarian Ravioli__________
<strong>Registration</strong><br />
Please refer to the enclosed information for the various fee options and what is included in each option. Prices are per person.<br />
Adults:<br />
*Early Bird Fee (by 5/10) or Regular Fee (after 5/10)<br />
Full weekend (Thursday–Sunday) # ________ @ $360.00 @ $385.00 = $ __________________<br />
Partial weekend (Friday–Sunday) # ________ @ $295.00 @ $320.00 = $ __________________<br />
Optional:<br />
<strong>Class</strong> photo # ________ @ $ 25.00 @ $025.00 = $ __________________<br />
Saturday All-<strong>Alumni</strong> Lunch Extravaganza** # ________ @ $ 17.00 @ $ 17.00 = $ __________________<br />
Thursday Bus Tour 3-4 p.m. (limit 47 people)*** # ________ @ $ 0.00 @ $ 0.00 = $ __________________<br />
Friday Bus Tour 11 a.m.-12 p.m. (limit 47 people)*** # ________ @ $ 0.00 @ $ 0.00 = $ __________________<br />
Friday Johnson Art Museum Tour 11 a.m-12 p.m. (limit 40 people)*** # ________ @ $ 0.00 @ $ 0.00 = $ __________________<br />
* Please note: Early Bird deadlines end at midnight, Eastern Daylight Time.<br />
** All-<strong>Alumni</strong> Lunch Extravaganza will cost $21 at the door.<br />
*** 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.<br />
Please contact Meyer Gross if you have special circumstances, meyeragross@yahoo.com; (212) 223-2588.<br />
Housing<br />
TOTAL REGISTRATION FEE: = $ _______________<br />
Alice Cook House has a few double rooms, a handful <strong>of</strong> suites, and mostly single rooms. There are no private bathrooms. Double rooms will be<br />
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<br />
specific party, please indicate the name <strong>of</strong> the person when completing the Housing section <strong>of</strong> your <strong>Reunion</strong> registration. The party you request<br />
on your <strong>Reunion</strong> registration must request you on their form. Requests need to be received by the May 10 early bird registration deadline. This<br />
is not a guarantee <strong>of</strong> placement with or near the party you request.<br />
The university residence hall charge is $58/adult per night, or save $38 by staying all 3 nights at a total cost <strong>of</strong> $136/adult.<br />
The <strong>Class</strong> <strong>of</strong> <strong>1958</strong> headquarters will be located in Alice Cook House. (Residence halls are non-smoking.)<br />
I/We will be staying on campus. OR I/We will be staying elsewhere. Please indicate where: ___________________________________<br />
I/We would like to room near: ___________________________ Name:_____________________________________________________________<br />
Total number <strong>of</strong> adults ____________________ × $136.00 for all 3 nights _<br />
OR<br />
Total number <strong>of</strong> adults ____________________ × Total nights __________ × $58.00 per night<br />
= $ __________________<br />
= $ __________________<br />
___________________________ ____________________ TOTAL HOUSING FEE: = $ ________________<br />
If you have a mobility impairment that requires a special housing assignment (near entrance, first floor, etc.), please explain below. Special<br />
housing assignments can only be made if registration forms are postmarked by 5/24/13.<br />
Special housing need: ______________________________________________________________________________________________________<br />
The <strong>Class</strong> <strong>of</strong> <strong>1958</strong> has a limited number <strong>of</strong> rooms at two hotels for <strong>Reunion</strong> weekend: Courtyard Marriott (607) 330-1000, and Ramada Inn (607) 257-3100.<br />
Please call direct for reservations, and remember, first come, first served!<br />
Payment<br />
If you are paying with a credit card, please consider using our secure online system to register.<br />
Subtotal for registration (from above)<br />
I have enclosed a check made payable to Cornell <strong>Class</strong> <strong>of</strong> <strong>1958</strong>. Check # ____________________<br />
I am using my Visa / MasterCard / Discover / American Express (circle one).<br />
Subtotal for housing (from above)<br />
= $__________________<br />
= $ __________________<br />
TOTAL AMOUNT DUE: = $________________<br />
Credit Card Number ___________________________________________________________________ Expiration Date _________________________<br />
Name as it appears on your credit card _________________________________________________________________________________________<br />
Signature/Date ___________________________________________________________________________________________________________<br />
Receipt <strong>of</strong> your registration will be acknowledged. Until May 24, 2013, all registrations are fully refundable.<br />
Refunds will not be processed until after <strong>Reunion</strong> weekend.