25th Reunion

Mail in Registration Form or

Register online and use PayPal at http://lrhall86reunion.eventsbot.com

Name: _________________________________________________________
(Include maiden name if married)

Address: __________________________________________________________

__________________________________________________________

Email Address: _________________________________________________________

Home Phone: _____________________ Cell : ________________________

Indicate below the number of adults and children who will attend:

Number of adults:_________
Number of children age 13 and over:___________
Number of children under the age of 13: ________

**Fee Schedule (please indicate the # for each) and register by April 15th:

April 15, 2011 deadline (per adult) ______ x $80 = ______

After April 15 (per adult) ______ x $95 = ______

A’ la carte individual Guest Prices:

Friday night (adults only) ____ x $20 = ____
Saturday Picnic (include children age 13 and above) ____ x $15 = ____
Dinner/Dance Party (adults only) ____ x $45 = ____

T-Shirts: Strongly encouraged for the picnic (Indicate the number next to the size)

$ 10 each for Small: _____ Medium:_______ Large: ______ X-Large: ____

$ 12 each for 2X _______
$ 12 each for 3X _______

Total Amount Enclosed: $ _________

Please return this form, along with method of payment (check, cashiers check, money order) to
LR Hall ‘86 Reunion. PO Box 242211, Little Rock, AR 72223
Registration deadline and fees due by May 31, 2011.