Rebeleer Reunion Form

EAST HARDIN REBELEER REUNION 2012

Registration Form

Date: June 16, 2012 Location: Pritchard Community Center – 404 S. Mulberry-Elizabethtown

Time: 4:00 p.m. – 11:00 p.m. (Dinner at 6:00 – short program to follow, but please come at 4:00!)

YOUR NAME _____________________________MAIDEN NAME ______________ CLASS OF 19_____

Street Address ______________________________________________________________________

City _________________________________________ Zip Code ______________

Phone Number(___)______________ email address ______________________________________

Years you were a member of the Rebeleers 19___ - 19___ instrument/role ___________________

WE HAVE LOTS OF PLANS! Please take a moment to list 1-5 of your favorite band memories. Be

specific or general… it doesn’t matter! If you need more room, feel free to use the back of this form,

attach another page, or email them to us.

__________________________________________________________________________________

WE NEED YOUR HELP! If there are any special people/volunteers who gave above and beyond during

your years in the band, would you tell us who they are? Include contact information if you have it.

__________________________________________________________________________________

____ YES, I have pictures that I will scan and send to: rebeleers@gmail.com (The sooner the better!)

____ YES, I have the following mementos I will bring to share and/or display: __________________

__________________________________________________________________________________

TOTAL NUMBER of PEOPLE ATTENDING ______ ($20.00 per person) Check Total: _____________

Make your check payable to: Rebeleer Reunion.

Send this registration form and your check to: Rebeleer Reunion

c/o Glenda Murphy

725 Freeman Lake Road

Elizabethtown, KY 42701

PLEASE RESPOND BEFORE MAY 1, 2012.

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