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2018 AKRSS FAMILY REUNION

REGISTRATION FORM
JUNE 14-17, 2018 MEMPHIS

Name: _____________________________________________________________________________
Address: ___________________________________________________________________________
City: ________________________ State: _________ Zip: ________ Phone: _____________________
Cell Phone: __________________ Email:________________________________________________

Ancestral Family: ASHFORD KNOX ROBINSON SMITH SIMPSON

ACTIVITIES
THURSDAY FRIDAY
Welcome Ceremony at Double Tree Hotel Picnic
SATURDAY SUNDAY
Morning Options: National Civil Rights Museum, Coleman Chapel CME Church Service
Casinos, Golf, Shopping
Evening: Banquet

Name of Each Person Attending


Please use a separate form, if needed, for more attendees. (See next page for t-shirt sizes.)

First Name Middle Initial Last Name T-shirt Size


1. ________________________________________________________________________________
2. ________________________________________________________________________________
3. ________________________________________________________________________________
4. ________________________________________________________________________________
5. ________________________________________________________________________________

Accomplishments
List family and individual accomplishments (awards, degrees, recognition, etc.).

1. ________________________________________________________________________________
2. ________________________________________________________________________________
3. ________________________________________________________________________________
Registration T-shirt Sizes
Fees cover ALL activities, t-shirt, scholarship Extra t-shirts WILL NOT be ordered. Please
donation, and breakfast Friday, Saturday, and make sure you put the correct size on this order
Sunday. form.
Adult: S, M, L, XL, 2XL, 3XL
Youth: YXS (2-4), YS (6-8), YM (10-12), YL (14-
16)
Payment Information
Quantity
Adult Registration _____@ $135.00 = $ ______ Make check payable to:
John Simpson
Youth Reg.(5-12) _____@ $110.00 = $ ______
Family of 4 (-$20) _____@ $470.00 = $ ______ Mail completed form and check to:
Under 5 ______@ Free John Simpson
9260 Bluebird Hill Cove
Lakeland, TN 38002
Adult T-shirt
Size: _______ ______Free w/Reg. Email: jsimpson622@gmail.com
Youth T-shirt
Size: _______ ______Free w/Reg.
Total $___________
Amount Enclosed $___________
Balance Due $___________
Balance may be paid in four (4) payments.
Total due before April 30, 2018.

Pay Online with PayPal or Credit Card Accommodations


Go to (www.akrss.weebly.com) and click on the Double Tree Hotel 185 Union Avenue, 38103
Registration link to pay online via PayPal $129.00 per night. Go to: www.akrss.weebly.com
account to John Simpson 901-289-5163. You will 0r Call: 1-800-222-8733 ask for 2018 AKRSS
still need to postal mail or email your registration Family Reunion or group code AKR
form to John Simpson. Parking $10 per day.