Class Reunion Registration

Event
St Peter-Marian Class Reunion: Class of 1997 - Saturday 8/4/2007
Registration:	Class Member $70.00
Registration:	Non-Class Member $60.00
Photo:	Class Reunion Photo $10.00
Sub-Total:
Scholarship Donation:
Grand Total:
Do you require a special diet?	Yes No
Other Special Needs:
My photo is in the year book:	Yes No
If so, please provide page number:
Personal Information
E-Mail:*		Valid e-mail is required
First Name:*
Last Name:*
Address Line 1:*
Address Line 2:
City:*
State:*
Zip Code:*
Marital Status:
Gender:
Date of Birth*
Phone:*
Name Tag(s)
Name Tag1:*		first, middle, last
Name Tag2:		first, middle, last
Name Tag3:		first, middle, last
Credit/Debit Card Information
Card Number:*
Expiration Month:*
Expiration Year:*
Card Brand:*
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