Votaw Colony Museum, Inc.      
818 Gertrude Avenue    Richmond, CA 94619 
510-482-5634 

Reconnection II 2007 Registration 
Please print this page, fill out the registration form,
and mail to the address below. To pay by credit card, please click on the Network for Good link above.

NAME 

ADDRESS

CITY                                                               STATE             ZIP

PHONE                                          (Home/Cell)    

E-MAIL


All Seminars and Special Events are FREE.
 
Groves Center Bus Tour - $5.00 
      Limited seating.  First Come, First Served.

Banquet - $15.00 
      RSVP deadline Monday, August 6, 2007


Please reserve a total of                            banquet seat(s) for                                                            (Name of Organization)

Send your money order (payable to VCMI) with this form to: 
         Tisa Anders 
         12187 W. New Mexico Place 
         Lakewood, CO 80228
NO PERSONAL CHECKS ACCEPTED


We would appreciate your completing this brief survey.
 
I am a descendent of Colony.  Yes/No

I am an Exoduster descendent.   Yes/No                   
Family Name

From which state did your family migrate?

Circle all that apply: Student       Scholar       Historian       Teacher       Black History Buff       Genealogist

What is your occupation?

How did you hear about this event?

Why did you elect to attend this event?
 
Would you be willing to complete an exit evaluation of this event?