Announcing the Class of 2005 Harry Bjerke • Amy Chow• Dominique Dawes • Kelli Hill Jenifer lovell Moreno • John Roethlisberger • Chainey Umphrey
USA Gymnastics
H ALL OF FAME 2005 Induction Ceremony and Luncheon
Saturday, August 13, 2005 • Downtown Indianapolis Marriott Hotel 11:30 am - 1:30 pm REGISTRATION/TICKET FORM: Plan on attending this prestigious special event. Individual Tickets $35.00 per person Tables: $ 350.00 Full tables will be reserved. Individuals will be open seating . Tickets may be picked up at the National Congress Registration Desk at the Indianapolis Convention Center, August 10-13, or Saturday, August 13 at the Marriott Hotel beginning at 11 :00 a.m .
PLEASE PRINT: Please submit email address. Confirmation will be sent via email. Name_ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Member # (if Applicable}_ _ _ _ __ Address,_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ City_ _ _ _ _ _ __ _ _ _ __ __ __ State_ __ _ _ _ _ __ Zip Code_ _ _ _ _ __
*Email Address (Required for confirmation} _ _ _ _ _ _ __ _ _ _ _ _ __ _ _ __ _ _ _ __ Phone: Daytime _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Evening _ _ _ _ _ _ _ _ _ _ _ __ Credit Card Number_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Exp. _ _ _ _ _ _ _ _ _ _ __ Name on card _ _ _ _ _ _ _ _ _ _ _ _ _ Signature_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ # of tickets _ _ _ _ _ _ _ _ _ _ _ _ @ $35 each . # tabl es @ $350 (10 seats per table ) _ _ _ __
I would like to make a donation to the Ha ll of Fame $_ _ _ _ _ _ _ _Total a mount due $_ _ _ _ _ __ rese rved in the name of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ All 10 tickets per table will be in one envelope for pick up. Table(~
* All donations will be listed in the Hall of Fame Program, National Congress Guide and USA Gymnastics publications
Fax form with credit card information to 317-692-5212 Or mail form and check (made out to USA Gymnasti cs) to: USA Gymnastics Hall of Fame Ceremony 201 S. Capitol Ave, Suite 300 Indianapol is, IN 46225
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TECH NI QUE· J UNE 2005
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