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El Mirage Reunion Registration Form

Print this page, fill it out and mail it to:
Patrick Panzera
1931 Emma Lee Lane
Hanford CA 93230
(559) 584-3306 Voice (7am to 4pm)
(559) 584-2513 Voice (4pm to 10pm)
panzera@cnetech.com (email)

Quantity	Description	Price each	Amount
(_____) (_____) (_____) (_____) (_____) (_____)	*Reunion Banquet Tickets* T-Shirts Small........................................................... Medium....................................................... Large.......................................................... Extra Large................................................ Add for shipping, each shirt, if you are not attending the Reunion. If you are attending, the shirts will be handed out at the Reunion.	$32.00 $16.00 $16.00 $16.00 $16.00 $3.50	$__________ $__________ $__________ $__________ $__________ $__________
		Enclosed	$__________

Today's Date: _

Name(s):___________________________

Address:_City/St/Zip:______

Phone:_ Email Address:________

Check Number:_

Checks: Please make checks or money orders payable to Patrick Panzera.

You do not have to attend the Banquet to purchase shirts.

Remember, all charges are refundable if you are unable to attend and at least 5 days notice is given.

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El Mirage Reunion Registration Form

Today's Date: _____________________ Name(s):_________________________________________________________ Address:_____________________City/St/Zip:__________________________ Phone:___________________ Email Address:__________________________ Check Number:___________

Today's Date: _

Name(s):___________________________

Address:_City/St/Zip:______

Phone:_ Email Address:________

Check Number:_