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I. Participation Information 

Name___________________________________________________________

Address_________________________________________________________
City ______________________________ State _____  Zip Code _________

Phone (including Area Code) ____________   Email_____________________

Name ______________________ Circle-one (spouse, son, daughter, mother, father) Age ______

Name ______________________ Circle-one (spouse, son, daughter, mother, father) Age ______

Name ______________________ Circle-one (spouse, son, daughter, mother, father) Age ______ 


Events               # of Persons X Price = Cost       Subtotal for each Event

Friday June 25
Banquet:
     12 year old to Adult ________ X $17.50 = __________       __________
   
       5 - 11 years        _________ X $ 9.00 = __________       __________

Saturday, June 26
-Tour - Lookout Mountain:
    18 year old to Adult ________ X $11.00 = __________       __________

      4-17 years           ________ X $11.00 = __________       __________

-Picnic:
    12 year old to Adult ________ X  $Free =  __________       __________

      5 11 year old        ________ X  $Free =  __________       __________

-Skate City:
     12 year old to Adult _______ X  $7.00 =   __________       __________

       5 -11 year old      _______ X  $7.00 =   __________       __________

Sunday, June 27
Brunch:
     12 year old to Adult _______ X  $5.00 =   __________       ___________

       5 - 11 year old     _______ X   $5.00 =   __________      ___________

Tee shirts:
Small____ Medium___ Large___ X Large___ $10  2XL___ 3XL___ $12 ______

                                                                    Subtotal      __________

Annual dues are $25.00 per family (a family is considered head of household and dependents claimed on tax form).  $25.00 for dues will be taken of of the top of any amount you send in and you may still have a blanace due whatever Reunion actvities you want to participate in.  If you have already paid your 2010 dues - THANKS!!!

                                                                Annual Dues $_________

                                                             Total Enclosed $_________

Signature:________________________________________________

Please mail Registration Form and your payment by March 7, 2010 to:
Juanita Harmon, 1645 N. Rutherford, Chicago, IL  60707


FAMILY MEMBERS THAT HAVE REGISTERED FOR THE 2010 REUNION                

ARKANSAS                                     ARIZONA                           CALIFORNIA


                                                   


COLORODO                                   DELEWARE                          FLORIDA



GEORGIA                                       ILLINOIS                              INDIANA

 



KENTUCKY                                   MARYLAND                          MICHIGAN




MISSOURI                                   NEBRASKA                         NEW HAMPSHIRE




NEW YORK                                  OKLAHOMA                         SOUTH DAKOTA 



TENNESEE                                TEXAS                                         VIRGINIA

 


                                   

WISCONSIN


Updated: December 26, 2009




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