NLD74
REUNION QUESTIONNAIRE/ORDER
FORM
PLEASE PRINT
(Complete even if you can't attend)
REUNION
DIRECTORY INFORMATION
NAME: First Name________________________________Middle Name_______________________
Maiden or Last Name__________________________Married Name __________________________
Street Address______________________________________________________________________
City_____________________________________________State____________ Zip______________
Home Phone #(________)______________________ Work Phone #(________)__________________
E-Mail Address:_______________________________________Fax #_________________________
Birth Date_______________________ S.S. #___________________________Grad Year________
Occupation_____________________________Place
of Employment___________________________
Most Vivid High School Memory_________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
SPOUSE / PARTNER INFORMATION Date Married_________/__________/__________
Name: First_____________________
Maiden______________________ Last____________________
Spouse's High School __________________________________________ Grad Year______________
Children(s) Name(s)(incl
ages)_________________________________________________________
___________________________________________________________________________________
Name of Guest______________________________________________________
Are you planning
on staying at the hotel? Yes_____ No_____ If Yes, how many nights? ______
Call the Hyatt Regency Pier 66...At 954-525-6666 for room rates,
between 8am & 5pm and mention that you are with the Miami Norland Class
of 1974.
Deadline for hotel reservations is June 4, 2004. Availability on a first come,
first served basis.
MIAMI
NORLAND 1974
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 / Complimentary Program Book for Grad only |
REUNION
BOOK ADS
Must be camera ready (black & white). |
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#Att.Full
Wknd (incl book) ____ x 120.00/each = ______
|
Ads
and ad payments are due upon ordering.
|
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#Att.
Friday only ( book extra) ____ x 50.00/each =
________
|
#
Full Page Ads (8½ x 11)
___ x 75.00/ea= _______ |
|
#Att.
Saturday only ( book incl) ____ x 90.00/each =
_______
|
#
½ Page Ads
______ x 50.00/ea =______ |
|
#
1/4 Pg. or Business Card
______x 35.00/ea =______ |
|
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REUNION
SOUVENIRS
|
#
Personal Dedications (60 spaces)
____ x 20.00/ea =______ |
|
#
Extra Books (incl tax & s/h) _____ x 17.00/each
=__________
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REUN. TICKETS $______ + REUN. SOUVENIRS $______ + 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 May 17, 2004, by Certified Mail. All refunds are subject to a 15% administrative processing charge. Refunds are processed after the reunion. No exceptions.
Signature__________________________________________________________
(NLD74)
7/04 1/20/2004
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