PSL 2010 FAMILY REUNION REGISTRATION FORM
Name:
Name of Spouse:
Email Address
Your Mailing Address:
Address:
City: State: Zip:
Telephone Number:
Number of seniors 65 years old and above that will be attending:
Name(s) and Age:
Number of adults 18 – 64 years old that will be attending:
Name(s) and Age:
Number of youth age 12 - 17 years old that will be attending:
Name(s) and Age:
Number of children 6 - 11 years of age that will be attending:
Name(s) and Age:
Number of children 5 years and younger that will be attending:
Name(s) and Age:
T-SHIRTS: Please indicate the # of shirts in the box next to your desired size.
Adult Sizes
Small Medium Large XL 2X 3X
Youth Sizes
X-Small (2-4) Small (6-8) Medium (10-12) Large (14-16)
T-Shirts - at 15.00 each (2XL, 3XL) = $
at 13.00 each (small, medium, large, XL) = $
at 10.00 each (youth sizes) = $
Total T-SHIRT order = $
SOUVENIER BOOKS at $20.00 each = $
REGISTRATION FEE $ (Reunion Fee amounts listed below)
Please base your fees on the family member’s age on the day of the reunion.
$200 = Family (covers up to 2 adults and 3 children ages 6-17 per household)
$120 = Couple age 18 to 64 $ 75 each = Individuals age 18 to 64
$ 45 each = Youth age 12 to 17 $ 35 each = Children age 6 to 11
No Charge = Seniors age 65 and older No Charge = Children age 5 and under
(+) Add Registration Fee, T-Shirt order and Souvenir Book order for GRAND TOTAL $
Payment Choice for balance (please check one option):
Option 1: Mail check or money order for full payment due now or before 02/01/ 2010
Option 2: Use PayPal.
If mailing your fee, make your check or money order payable to:
PSL Reunion
Total amount enclosed: $
Mail to: PSL