Registration Form
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Washington School Reunion, Inc.
August 3-5, 2017
Divine Holiness Outreach Center Ministries
1109 E. 18th St.
Caruthersville, MO 63830
Registration Form
Name___________________________________________________________________
Address_________________________________________________________________
City/State/Zip____________________________________________________________
Telephone (H) __________________ Cell_________________________________
Email___________________________Fax____________________________________
Year Graduated____________ Teacher_____ Years Taught____________
Early Registration $75.00 --- After July 10th $90.00 --- Children 10 and under $30.00
Please mail registration form(s) with check or money order by July 10, 2017
No Personal Check after July 10, 2017
Make checks or money order payable to: Washington School Reunion, Inc.
Registration fee includes:
T-Shirt (Adult Sizes) S__M__L__XL__XX__XXX__
Gospel Fest
Business Meeting/Meet and Greet
Souvenir Booklet
Souvenir
Saturday Night—Dinner
Please consider giving a donation to:
Booker T. Washington Monument: $_______________
C. J. Lunderman Scholarship: $_________________
NO CHECKS WILL BE ACCEPTED DURING THE REUNION WEEKEND. (Except for donation(s) for the monument/scholarships)
All Monies should be sent to: William (Leon) Thompson, Treasurer
1809 Slippery Rock Court
Naperville, Illinois 60565
AD FOR SOUVENIR BOKLET
Washington School Reunion, Inc.
August 3-5, 2017
Caruthersville, MO 63830
Name: _________________________Address: _____________
City: _________________________________ State: ______ Zip: _____
_____Full Page $80.00
_____Half Page $55.00
_____1/4 Page $35.00
_____Patron $15.00
Make check payable to: Washington School Reunion, Inc.
Attention: William (Leon) Thompson, Treasurer
1809 Slippery Rock Court
Naperville, Illinois 60565
E-mail: 53662000@msn.com
Please support our organization by purchasing an ad for the 2017
reunion souvenir booklet. All ads should be submitted camera ready. You may mail ads or email ads to William (Leon) Thompson
Please return form and fee(s) on or before June 30, 2017