Registration Form

Registrants Name (for women please include maiden name if married):_____________________________ Class of:__________ Address:________________________________________________________________ City/State:________________________ Home Phone:_________________ Cell Phone:_________________ E-mail address: _________________________________________ Cost: The cost for attending the reunion will be $70 per person excluding the cost of golf and class night activities (see note 1). This cost covers the funds for the banquet, prizes for the tournaments, stocking the hospitality room and other incidentals like reproduction and postage. Reunion attendance: Names of attendees other than registrant: (see note 2) ___________________________________ Golf: #_____ X $ $80 = $_________ Names of golfers other than registrant: _____________________(note: Please signify if you are interested in the second day. Funds for that round will be handled separately by Tosh Miyashiro.) Interested________ As always, donations are graciously accepted: MAHALO Addendum The following costs are provided for each respective class night activity: Class of 61 ($40/person), Class of 62 (NC), Class of 63 (Open), Class of 64 ($35/person). Please fill in this section if you plan to attend the Wednesday class night activity. Name: _____________________________ $____X Person(s) = $________ Names of attendees other than registrant: ______________________________ For those registrants that have spouses/significant others who have graduated from HHS 61-64, and plan to attend their class night activity, please fill in this section. Name: _____________________________Class ____ $____X Person = $_________ Total remittance = $_________ $ ________ #_____ X $70 = $_________

Request that this form including funds be submitted not later than September 1, 2013
Make check payable to:

HHS61234 HHS 61234 112-B North 3rd St Las Vegas, NV 89101

Mail registration form and check to:

Note 1: Each class, with the exception of class of 63, will be hosting a class night on Wednesday. The cost of attending this activity (if any) will be reflected in an addendum to this registration form. Note 2: For those registrants that have spouses/significant others that have graduated from HHS 61-64 please annotate the year graduated next to their name. To expedite the scheduling of the various activities please annotate which activity/activities that you and/or other attendees on this registration form plan to participate in: Hanfuda: _____________Slots:___________ Scavenger Hunt:___________