RESERVATION FORM

EVENT: Right to Life National March - Gaylord Right to Life "Red Eye" Bus Trip

DATE: Thursday, January 26, 2016 - Saturday, January 28, 2017

LOCATION OF MARCH: Washington D.C. January 27, 2017

DEPARTURE TIME: Approx. 2:30 p.m. Thursday, January 26, 2017 - Calvary Baptist Church north parking lot

RETURN TIME: Approx. 8 a.m. Saturday, January 28, 2017 - Calvary Baptist Church north parking lot

TRANSPORTATION: Charter Bus

COST: $125 (meals and spending money are NOT included)

DEPOSIT: $25.00 required by December 15, 2016.  Balance Due January 15, 2017.

Space is limited; reservations will be honored on a first come basis.
Minors traveling without parent/guardian will be required to provide a notarized emergency medical
release form before getting on the bus.

___________________________________________________________________________________________________________________

YES! Please reserve my place on the "Red-Eye" bus trip to Washington D.C.
for the 2017 March for Life.

Number of Seats:  _______ Adult        Name(s):_____________________________________________

                                                                                    _____________________________________________

                           _______ Students  Name(s):_____________________________________________

                                                                                    _____________________________________________

Address:_______________________________________________________________________________________

City:____________________________________________State:_________Zip:________________

Phone: (H)________________________________  (w)_____________________________________

             (Cell)______________________________  Email:____________________________________

 

For Students Only:

School:_______________________________________________________ Grade:_________

Parent/Guardian signature (if under 18):__________________________________________________

Please return this registration form along with full payment by January 15, 2017 to:

Gaylord Right to Life
554 McCoy • Gaylord, MI 49735