RROADS
REUNION QUESTIONNAIRE/ORDER
FORM
PLEASE PRINT
(Complete even if you can't attend)
NAME: First____________________
Maiden_________________ Last_________________________
Street Address_____________________ City_____________________State______ Zip___________
Home Phone #(________)______________________ Work Phone #(________)__________________
E-Mail Address:__________________________Fax #_____________________Grad Year________
ARE YOU ATTENDING?
Yes_____ No_____ ARE YOU BRINGING A GUEST? Yes_____ No_____
Are you planning
on staying at the hotel? Yes_____ No_____ If Yes, how many nights? ______
For room rates, call the Wyndham
Miami Beach Resort... at (305) 532-3600 & mention Roosevelt Roads High School.
**Deadline for hotel reservations is May 15, 2003. Availability
on a first come, first served basis**
Occupation_____________________________Place
of Employment___________________________
Are you Married? Yes_____
No_____ Date Married_________/__________/__________
SPOUSE INFORMATION
Name: First_____________________
Maiden______________________ Last____________________
Spouse's High School __________________________________________ Grad Year______________
Date Married___________________________________#
of Children____________________________
Children(s) Name(s)(incl
ages)_________________________________________________________
Most Vivid High School Memory_________________________________________________________
___________________________________________________________________________________
YOUR MIDDLE NAME________________
BIRTH DATE____________ S.S. #___________________
PERMANENT CONTACT: NAME______________________________
Phone#___________________
ADDRESS_____________________________ CITY____________________
STATE___ ZIP________
ROOSEVELT
ROADS HIGH SCHOOL
ORDER
FORM
Please make a copy for your records before mailing.
If you fax your credit card payment, please DO NOT mail the original.
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REUNION
TICKETS
Per person |
REUNION
BOOK ADS
Must be camera ready (black & white). |
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Ads
and ad payments are due upon ordering.
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#Att.
Thursday( book extra) ____
x 65.00/each
= ________
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#
Full Page Ads (8½ x 11)
___ x 75.00/ea= _______ |
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#
½ Page Ads
______ x 50.00/ea =______ |
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#
1/4 Pg. or Business Card
______x 35.00/ea =______ |
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#
Personal Dedications (60 spaces)
____ x 20.00/ea =______ |
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REUN. TICKETS $______ + REUN. BOOK ADS $_______ = TOTAL DUE _________
Make
checks payable to First Class Reunions or pay in full by credit card
Signature required for processing.
You will receive your tickets at the reunion.
Select One: VISA___ MASTERCARD___ Card #_____________________________ EXP.________
Name that appears on card (please print)__________________________________________________
I hereby authorize First Class Reunions Inc. to charge my credit card for the above amount. Cancellations and Requests for Refunds will be accepted in writing until April 26 , 2003. All refunds are subject to a 15% administrative processing charge. Refunds are processed after the reunion. No exceptions.
Signature__________________________________________________________
(RROADS)
6/03 8/01/2002
First Class Reunions
7040
W. Palmetto Park Rd. Suite 4-304
Boca Raton, FL 33433
Toll Free: 1 (800) 741-4723
Fax: (561) 362-4993