Reunion Registration Form




(Open to Smith classes 67,68,69,70,71 and guests)


Costs for this event will be $50 per person for all who register (and guests) prior to the event (registration and payment postmarked by September 18th). Costs will be $60 at the door the evening of the event.  Cancelation refunds will be honored up to but not after September 18th.

Please complete the form below for registration.  PLEASE PRINT LEGIBALY 

CLASS MEMBER NAME (and Class year) the way you want it on your nametag



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GUEST(s) NAME(s)  (and Smith class year if applicable) the way you want it on nametag(s)



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Mail registration forms and checks to:

Smith 69 reunion

c/o Rick Burnham

314 Saint Nicholas Trail

Gibsonville, 27249


Make checks payable to:

Rick Burnham 69 reunion


AMOUNT ENCLOSED:   $_________________