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JANUARY, JACKSON, SIMPSON, BURDELL FAMILY REUNION

REGISTRATION FORM

 

 

* Registration Fee ($10.00 per Adult) 16 yrs. and older

 

 

Family Name:_______________________________________________________

 

Address:___________________________________________________________

 

City/State:____________________  Zip:_____________  Phone:______________

 

Name of adults attending the Reunion                Total number of children

 

1.  _________________________________                         __________

 

2.  _________________________________                         __________

 

3.  _________________________________                         __________

 

4.  _________________________________                         __________

 

Total Number of Adults  _______________       Total registration cost _________

 

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*TEE SHIRT REGISTRATION

 

$17.00 per person   *Payment must be made in advance

 

____ 4XL, ____ 3XL, ____ 2XL, ____XL, ____ L, ____ M, ____ S, ____ XS

 

Total number shirts _____  Total Cost _____

 

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*BANQUET DINNER (Buffet)

 

$33.00 per person, 25% off children under 11, children 3 and under free.  *(This price includes 18% service charge and applicable sales tax)

 

Number of Adults _____  Number of children _____  Total Cost _____