Registration

“Growing Up In Rockford” Reunion 2009 Please mail completed registration forms with your check or money order by May 26,2009 to: LaTasha Lyons 195 Ruby Ct Gardena, CA 90248 If paying by Credit Card 1. Email Completed Registration Forms to [email protected] 2. A payment request form will be sent to you via email.

REGISTRATION FORM ADULTS: Name _________________________________________________ Name _________________________________________________ Name _________________________________________________ Name _________________________________________________ CHILDREN & AGE: Name _________________________________________________ Name _________________________________________________ Name _________________________________________________ Name _________________________________________________ Mailing Address _______________________________________ ______________________________________________________ ______________________________________________________ Phone Number _________________________________________ Email __________________________________________________ ___ I would like to order a Reunion Memory Book for $15 (Complete and send Reunion Book Information with payment) ___ I would like to make a monetary donation to the Reunion (all donations are used to offset cost of expenses) Total Fees Enclosed (check all that apply) Registration Fee ___ Adult (18+) $20 x ___qty ___ Child (3-17) $15 x ___qty Reunion Book

___$15 x ___qty

REUNION BOOK FORM

Include a photo (optional) past and present. If you’re not ordering a book, we still would like to include you! Name:

__________________________________________________ Maiden Name:

__________________________________________________ Spouse:

__________________________________________________ Children Names:

__________________________________________________ __________________________________________________ Address:

__________________________________________________ __________________________________________________ __________________________________________________ Phone:

__________________________________________________ Email:

__________________________________________________ Share information about your life, family, career, hobbies

__________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ If you like, attach another sheet of paper or email your story/picture to [email protected] __ Yes, please include my contact information in the Reunion Memory Book __ No, please do not include my contact information in the Reunion Memory Book. ___ I am not ordering a book at this time, but here is my information to include in the book.