Medical Registration Form

Medical Registration Form
(All information contained on this form will be confidential and destroyed after the Reunion)

If you/or your spouse are on Oxygen Theraphy or Dialysis please let the committee know and we will assist you in locating a facility
that can accommodate you during your stay in the area. We have a top notch hospital and I am sure we will be able to accommodate
your needs. Special equipment needed (wheel chair, walkers, include your height/weight)