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Print out this form and send with check to address below....

Laughlin Reservation Form

February 19 February 24, 2017

Cost - $ 75.00 per person, $80.00 per person after Jan 1, 2017

 

Name: __________________________________________________

Year Graduated From NE: __________

Spouse or Guest Name: ________________________________

If Spouse or Guest Graduated From NE... Year Graduated: __________

Address: ________________________________________________

City: _______________________________

State: ________________

Zip: __________________

Phone: ______________________

Email Address: ___________________________________________

 

Indicate Interest: # ____ Jet Boat to Havasu (optional)

  (We will contact you with cost of jet boat event)

Amount Enclosed: $__________________

 

Mail Checks Payable To: "Carol Lee Piraro"

Send This Form And Check To:

Carol Lee Piraro
5245 S. 68th E Ave.
Tulsa, OK  74145