SEND THIS FORM AND PAYMENT TO:

Midwest Willys Jeep Reunion c/o Tom R. Johnson 7078 Crisptown Road Mountain Grove, MO 65711-3045

PHONE: (417) 668-5555

YOUR NAME________________________________________	DATE_______________________________________
ADDRESS__________________________________________	ZIP CODE:___________________________________
CITY/STATE_________________________________________	PHONE #____________________________________
E-MAIL ADDRESS____________________________________
Please include your telephone number and email address. Is this your first time attending the reunion?  YES NO Willys Vehicle Registration [ For Willys vehicles you are bringing to the Reunion ] Willys Vehicle _______________________Year______________Model_______________________ Willys Vehicle _______________________Year______________Model_______________________ Willys Vehicle _______________________Year______________Model_______________________ Preregistration: $8.00 per vehicle.      Number of Vehicles___________   Total Fee $____________ ************ Saturday Banquet Registration [ Note: NO Banquet tickets will be available at the Reunion. ] Adults ________ @ $17.50 per ticket ( includes tax and gratuity )   Total $____________ Children ________ @ $8.75 per ticket ( 12 years and under )       Total $____________ ************ TOTAL DUE for Vehicle Registration and Banquet Tickets **   Total $____________ ** NOT Refundable after September 10th deadline. ************

Please note: Midwest Willys Jeep Reunion is not responsible for lost, damaged, or stolen items.

Please make check or money order PAYABLE TO: Midwest Willys Jeep Reunion