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

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
If "Yes," what is your guest's name?