REGISTRATION FORM

Shipmate’s Name: (as you would like name to appear on name badge)

Year(s) aboard the Franklin: From: _________ To: ________

Crew: Blue _________ Gold _________ Commissioning _________ Inactivation __________

Your Highest Rank/Position aboard the Franklin:

Your Current Rank/Position (includes USNR & Retired shipmates):

Spouse/Guest: __________________________________________ (as you would like name to appear on name badge)

Mailing Address:

City: State: Zip:

Phone: E-mail Address:

Additional Guests/Children: (please continue on reverse if more space is required)

Age

Name: (if under 12) Relationship to you:

_______________________________________________________ ________ ____________________________________________

REGISTRATION FEES:

► SOCIAL EVENTS (see enclosed Pink Flyer for details):

● Friday Evening Social Gathering: ______ x $22.00 = $ __________

● Saturday Grand Banquet: Adults ______ x $35.00 = $ __________

Children (under 12) ______ x $20.00 = $ __________

(please indicate entree choices & number here): Prime Rib ______ Baked Stuffed Shrimp _____ Stuffed Chicken Breast _______

SPECIAL DIETARY MEAL: _____ (Description) ________________________________________________________________________________

● Sunday Farewell Brunch: ______ x $13.00 = $

► GOLF OUTING (see enclosed Green Flyer for details): ______ x $50.00 = $

(participation is limited to a field of 28 players – first come, first served)

► SUB SCHOOL TOUR (see enclosed Gray Flyer for details):

(participation is limited to 60 attendees – first come, first served)

(includes transportation and lunch at Base Galley) ______ x $26.00 = $

► MYSTIC RIVER CRUISE (see enclosed Yellow Flyer for details):

(participation is limited to 47 attendees – first come, first served) ______ x $40.00 = $ SOLD OUT

► SSN TOUR (see enclosed Blue Flyer for details):

(participation is limited to 25 men per ship – first come, first served)

(includes transportation) ______ x $27.00 = $

► REUNION ADMIN. FEE*: Adults: ______ x $25.00 = $

Grand Total = $

**** COMPLETED REGISTRATION FORM AND FEES ARE DUE BY AUGUST 1, 2004****

Please make checks payable to: USS BENJAMIN FRANKLIN (SSBN640) ASSOCIATION

Mail completed registration form and your check to: ALLEN J. EXELBY

(a self-addressed legal sized envelop is in the large envelop) 110 Meriden Drive, Newark, DE 19711

*THE ADMIN FEE IS A NON-REFUNDABLE CHARGE THAT COVERS THE COSTS OF MAILINGS AND OTHER EXPENSES INCURRED IN SETTING UP THE REUNION.

IT IS A FIXED COST REGARDLESS OF THE NUMBER OF EVENTS YOU PARTICIPATE IN.