Name of person making reservation:____________________________________
CCA Membership Number:_____________________________
Your Callsign:__________________________
Number of banquet tickets requested:_______  x $35.00 each = Total Enclosed: $_______

Please print all the names (including your own) of the persons you are registering for.
This information will be used to make the name tags:

Your Name________________________
Your Callsign _____________________
Your Hometown____________________
Chicken or Beef____________________

Name________________________
Callsign _____________________
Hometown____________________
Chicken or Beef____________________

Name________________________
Callsign _____________________
Hometown____________________
Chicken or Beef____________________

Name________________________
Callsign _____________________
Hometown____________________
Chicken or Beef____________________


If you leave the food choice blank, you will be served Beef!

Make checks payable to the Collins Collectors Association. Checks must be in US funds and drawn on a US bank. Please write your CCA membership number and callsign on your check.  Mail to:      Collins Collectors Association
                 P. O. Box 354
                 Phoenix, MD  21131