THE COUSINS’ 
pastedGraphic.png FAMILY REUNION
REGISTRATION FORM
(EARLY BIRD REGISTRATION PACKET DUE NO LATER THAN DECEMBER 31, 2022)
“
pastedGraphic_1.png
Family Name (Circle one): Barnes, Brevard, Bufford, Cauthen, McGriff, Peay, Truesdale, Vaughn
Submit payment either by Check or Money Order.
If by check, make payable to
Regardless of payment type, you must mail the Registration Form to:
Elaine Shannon
Georgia Cousins Chapter
1317 Cochran Crossing
McDonough, GA 30252
NAME: 
pastedGraphic_2.png
ADDRESS:
PHONE NUMBER: ________________________________ EMAIL:
|
Name Individual Family Member(s) / Guest(s)
|
Adult 18 & over
|
Youth
12 - 17
|
Child
4 -11
|
Entrée
Choice
|
Youth Outing
|
Bus
Tour
|
Prayer Breakfast
|
T-Shirt Size
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
DINNER:
|
Activities
|
Adult
|
Youth
|
Child
|
|
Gala Banquet, Dinner and Dance
|
$65.00
|
$35.00
|
$25.00
|
|
Atlanta Black History Bus Tour, Black Wall Street, and Stone Crest Mall (includes roundtrip transportation & stop for lunch)
|
$30.00
|
$20.00
|
$20.00
|
|
Prayer Breakfast
|
$25.00
|
$20.00
|
$20.00
|
T-SHIRTS:
Adult (SM – 2XL) = $20.00 Adult (3XL – 5XL) = $25.00 Youth/Child (XS – XL) = $10.00 -$15.00
TOTAL SUBMITTED: $_______________ ◻ Check or Money Order ONLY
*Rates are for advance purchases only.
BANQUET AND PRAYER BREAKFAST TICKETS “MUST” BE PURCHASED NO LATER THAN FRIDAY, ON-SITE.
REFUND POLICY: A full refund (minus mailing cost) will be offered to individuals whose cancellations are before April 1, 2023. If you cancel after April 1, 2023, you will receive 50% of your refund. There will be “NO” refunds given for cancellations after May 1, 2023. There will be a $35.00 fee charged on checks returned by the bank due to insufficient funds. Registration confirmation/receipt and further information will be emailed if an email is provided.
¨ Check if you are a Cancer survivor (any type)
pastedGraphic_3.png
HOLIDAY INN & SUITES ATLANTA AIRPORT NORTH
DESCRIPTION OF GROUP AND EVENT:
The following represents an agreement between the Holiday Inn & Suites Atlanta North Airport and Georgia Cousins Chapter and outlines specific conditions and services to be provided.
ORGANIZATION: Cousins Family Reunion
Georgia Cousins Chapter/Host
CONTACT: Harold “Champ” Purvis
ADDRESS: 2776 Rex Rd.
Ellenwood, GA 30294
PHONE: (678) 834-3374
EMAIL: taymyson@yahoo.com
CONTACT: Elaine Shannon
ADDRESS: 1317 Cochran Crossing
McDonough, GA 30252
NAME OF EVENT: Georgia Cousins Family Reunion
OFFICIAL PROGRAM DATES: June 22, 2023 – June 25, 2023
GUEST ROOM COMMITMENT
The Hotel has agreed that it will honor these room rate prices until March 25, 2023. After that, the prices will go back to their regular rates.
|
DATES
6/22/23-6/25/23
|
RATES
|
Thursday
|
Friday
|
Saturday
|
Sunday
(Check Out)
|
|
ALL ROOMS
|
$109.00
|
|
|
|
|
|
SUITES (4)
|
$159.00
|
|
|
|
|
|
|
|
|
|
|
|
Daily Parking: $5.00
Hotel check-in time is 3:00 p.m. and check-out time is 11:00 a.m.
THE COUSINS REUNION
https://www.holidayinn.com/redirect?path=hd&brandCode=HI&localeCode=en®ionCode=1&hotelCode=ATLAP&_PMID=99801505&GPC=COU&cn=no&viewfullsite=true
To make your reservation please click the online booking link above that will take you directly to our website with COU code already
attached.
Enter your Arrival and Departure Date, press Enter
Select your Bed Type to make your reservation
If your guests would like to call our toll-free reservations department to make their reservation, please call 1-888-465-4329 and ask
for THE COUSINS REUNION or the Group Code COU to make their reservation
NOTE:
• Cut Off for Reservations: 3/25/23
• $5 Self-Parking for all Overnight guests and Day meeting Attendees for your Group.
Check-in Time: 3PM I Checkout Time: 11 AM
If you need to cancel or change your reservation it must be done 24 hours prior to your date of Arrival.
If you have any questions, or require special accommodations making your reservations, please contact me directly at 404-305-9990 or via email at czarina.devega@hiatlantaairport.com
We look forward to welcoming you to our hotel!
*****Please DO NOT Send Credit Card or other Payment Details through email. Ask me for a link to our PCI Compliant payments portal to securely capture these details. *****
| 