RESERVATION FORM
EVENT: Right to Life National March - Gaylord Right to Life "Red Eye" Bus Trip
DATE: Thursday, January 24, 2013 - Saturday, January 26, 2013
LOCATION OF MARCH: Washington D.C. January 25, 2013
DEPARTURE TIME: Approx. 2:00 p.m. Thursday, January 24, 2013 - Calvary Baptist Church north parking lot
RETURN TIME: Approx. 8 a.m. , January 26, 2013 - Calvary Baptist Church north parking lot
TRANSPORTATION: Charter Bus
COST: To be determined (meals and spending money are NOT included)
DEPOSIT: $25.00 required by December 14, 2012. Balance Due January 14, 2013.
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 2013 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 14, 2013 to:
Gaylord Right to Life
554 McCoy • Gaylord, MI 49735