Family Reunion Registration Form
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1FAMILY REUNION REGISTRATION FORM
Please be sure to complete the entire form
REGISTRATION DEADLINE: ________
Adults & Youth 13-83
$_____
Pre-Teens 12-6
$_____
__
$_____
Child 5 and under
$_____
Family Elders 84+
___
REGISTRANT’S INFORMATION
Name:
Cell Phone:
Address:
Email:
Home Phone:
Facebook:
REGISTRATION FEE
Adult
Teen
Child
Name and Age
Amount
$___
$___
$___
$
Example: Jane Doe - 28
1.
$
2.
$
3.
$
4.
$
5.
$
6.
$
7.
$
Subtotal Registration:
$
Grand Total:
Select Your Payment Options
☐
-‐
C redit
C ard
r
r
r
r
Please check appropriate box:
Check
Money Order
VISA
MasterCard
Expiration Date: _____________________
Card #: ____________________________________________________ Print Cardholder Name: _____________________________________
☐
-‐
P ayPal
PayPal Email Address: ___________________________________
☐
-‐
O ther
Describe: __________________________________________________________________________________________________________________________
Signature:
_ ________________________________________
P rint
N ame:
_ ___________________________________________
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Parent category: Legal