Reunion Registration Form

Your Name: *

First Name Last Name

Your Name in High School: *

First Name Last Name

If married, your spouse's Name:

First Name Last Name

Your mailing address: *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Cell Phone Number:

Area Code Phone Number

Landline Phone Number:

Area Code Phone Number

Your email address: *

Indicate your participation (Note some Saturday activities overlap): *

1. Thursday night social at DJ's Dugout (Cash bar) 2. Friday Golf outing ($55.00 Green fees/golfer) 3. Friday night at the Bellevue Events Center ($40/person included in Registration Amount) 4. Saturday morning High School tour (Free) 5. Saturday afternoon at Gene and Pam Francois (Free) 6. Saturday night dinner at the Platteview Country Club ($50/person included in Registration Amount) 7. Sunday at Stellas (Order off the menu)

Indicate your Friday and Saturday night attendance and the amount you are paying:

Calculate your Payment.

Making a deposit?

Total number attending x $25

OR

Making payment in full?

Number attending Friday Night x $40 plus

Number attending Saturday Night x $50

Friday Night Attendance: *

Saturday Night Attendance: *

Amount you are paying: *

Please make your payment by March 15, 2017.

Make checks out to Binnie Sautter/Bellevue 1967 Reunion and mailed to:

Binnie Sautter
4314 Anchor Mill Road
Bellevue, NE 68123

Registration Comments:

Please type the word below in the space provided: *