Midland Homecoming

Dinner - Dance Reservation Form

Please fill out form below and return with payment. Include a self-addressed stamped envelope with payment and reservation form.  We will send tickets or hold them at your request.

Reservations must be received by August 2, 2003 to:

Town of Midland

PO Box 306

Midland, MD 21542

Name:___________________________________________

Address: ________________________________________

__________________________________________________

__________________________________________________

Number of Tickets: ___________ X $12.00 = Amount Enclosed: _______________

For Information call: 301-463-5290 or 301-463-6768 or 301-463-2264