Registation Form
Please fill out the following information and press SUBMIT to continue the Registration Process.
Name
Maiden Name
Spouse Name
Address
City State Zip
High School
Class Year
Email Address
Home Phone
Work Phone
Are you attending the reunion?
How many people?
Would you be staying at the hotel?
How many nights?
Each registered alumni's information will listed in the Alumni Directory.
Please check what info should be listed.
Name
Address
Email
Telephone
COMMENTS:
Credit Card Payments:
VISA – MASTERCARD – AMEX – DISCOVER acceptable
Credit Card Type:
Card #:
Exp Date:
3 digit security code
(see last 3 digits on back of card, signature block):
Name on Card:
Address: (if different from above)
City: State: Zip:
AMOUNT OF PAYMENT:
5/04