Registration Form for A Remembrance of Elizabeth Black featuring Gene Shepherd
Complete and return this form with check for total Hook‐In and overnight accommodation fees.
Name ________________________________________________________________________ Address ________________________________________________________________________ Email _______________________________ Phone _______________________________
Hook‐In Fee (required) (Tuesday eve. and Wednesday activities, includes Wed. lunch only) $ 25.00 Overnight Accommodations at Massanetta Springs Conference Center (optional)
712 Massanetta Springs Rd, Harrisonburg, VA 22801, 540‐434‐3829, www.massanettasprings.org
If you would like to stay overnight on Tuesday and/or Wednesday nights, choose your building, indicate which nights you require a room and extend the total to the far right column.
(Do not contact Massanetta Springs directly for reservations. Reservations with this form only.) ___________________________________________________________________________________
Lodge: (hotel style room: private bath, 2 queen beds, WiFi, no TV) VERY IMPORTANT: Number of rooms in the Lodge are limited. If you want a Lodge room you must inquire to see if one is still available before sending in your registration form.
Contact Helen Vance at 703‐787‐8369.