Text Box: DESCENDANTS REGISTRATION

Name: ______________________________________________________________________

Address: _____________________________________________________________________

Phone: _________________  E-mail _________________________________

I am a descendant of: __________________    Who was at Fort Randolph in the yr/yrs: ________

I will be able to attend the event on May 15th 2010: ___yes ___ no

I would like to be put on the mailing list for the fort newsletter: ___yes  ___no

Please fill out, cut out and mail to:  Fort Randolph Committee, PO Box 86, Pt. Pleasant, WV 25550