REGISTRATION FORM

2003 NATIONAL WRESTLING HALL OF FAME

Connecticut Chapter Banquet and Induction Ceremonies

Sunday, March 9, 2003

Reception 5:00 PM – Banquet 6:00 PM

Location

Foxwoods Resort and Casino

“Grand Pequot Tower”

Rt. 2 Ledyard, CT 06339

Banquet Registration

Please make check ($55 per person) payable to “USAWCT” and return by February 24, 2003.

Name ________________________________________ # of Tickets ___________

Address ____________________________________________________________

Telephone # _____________________ Email ______________________________

I (we) are attending in honor of (recipient’s name) ___________________________

Honoree’s Special Contribution

Yes, I (we) want to honor (Honoree’s name(s)) _________________________________

and support the National Wrestling Hall of Fame by sending a special contribution of:

______ $25 ______ $50 ______ $75 ______ Other

Please make check payable to: USAWCT (USA Wrestling of Connecticut)

Your name will be included in the Banquet Program listed by each honoree if received in time for the printing deadline. Please write below how you wish to have your name listed.

Return completed form to: State Chapter of CT

350 Grovers Ave

Unit 1Q

Bridgeport, CT 06605