2026 Elie Solitaire Pantallion Family Reunion – Legacy Family Member Registration

2026 Elie Solitaire Pantallion Family Reunion – Legacy Family Member Registration

Please confirm your eligibility, provide your details, and share any special needs or comments to help us honor you.
Eligibility and Participant Information
Eligibility confirmation
Full legal name

First NameMiddle NameLast Name
Preferred name for badge
Date of birth

MonthDayYear
Date
Current age
Phone number
Please enter a valid phone number.Format: (000) 000-0000.
Email address
example@example.com
Mailing address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State
Current city and state
Family Lineage and Branch Details
Family Branch
Connecting ancestor name

First NameMiddle NameLast Name
Number of children
Number of grandchildren
Number of all great(s) grandchildren
Attendance, Companion, and Emergency Contact
Will a caregiver, aide, or family member accompany you?
Companion full name

First NameLast Name
Companion phone number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency contact name

First NameLast Name
Emergency contact relationship
Emergency contact phone number
Please enter a valid phone number.Format: (000) 000-0000.
Health, Access, and Support Needs
Special needs accommodations

Other
Please let us know anything else we need to know to properly care for, accommodate, and honor you.
Legacy Tribute Upload and Consent
Legacy Tribute Photo (Optional)

Cancelof
Consent to Use Information and Optional Photo for Reunion Tribute
Should be Empty: