Member's Name _____________________________________________________________________________
Additional Name _____________________________________________________________________________
CMSI#__________ Email Address ______________________________________________________________
Street Address _______________________________________________________________________________
City _______________________________________________________ State_________ Zip _______________
Children Attending: Yes ( ) No ( ) How Many _________________
Other Adults: Yes ( ) No ( ) How Many _________________
Number:___________ @ $25.00 = $___________ (To attend the meetings you must be registered)
Adults: Number___________ @ $29.00 = $___________
Children (12 and under): Number___________ @ $12.00 = $___________
Host Hotel: Hampton Inn — Manassas
7295 Williamson Blvd
Manassas, VA 20109
Will you be staying at the Hampton Inn, Manassas (Host Hotel)? Yes ( ) No ( )
The room rate will be $99.00 + tax per night. Make sure you tell them you are with Clan Montgomery or code: CLS to get this rate. Contacting the hotel by phone is the best way to guarantee you are getting the proper rate. Reservations must be made before August 5, 2021 to get the above rate.
You can also make a reservation online at
https://hamptoninn.hilton.com/en/hp/groups/personalized/M/MNZHAHX-CLS-20210903/index.jhtml, or you can go to http://clanmontgomery.org/agm.html and click the link for the Host Hotel.
Make checks for registration and dinner payable to CMSI.
Mail your check and this completed form to:
Karen Luster, Treasurer
6679 Clarks Meadow Dr
Bealeton, VA 22712 USA Form Last Updated: January 31, 2021