Registration Form

The 1978 & Friends Reunion/Celebration


 
The 1978 & Friends Reunion/Celebration is planned for August 15, 2009 at the Knights of Columbus, Oceanside, NY.
Please fill out this form and send it to Paul Rothenberg at paulrich1@aol.com

If you have questions, please send them to Paul at the above address.


 

Last Name: 
First Name: 
Maiden Name:
Email Address:
Street Address, City, State, Zip Code: 
Home Phone:
Cell Phone: 
Graduation year:
Are you bringing a guest? Yes
No
If "Yes," what is your guest's name?