SELACO Alumni Association
Reunion 2021 Registration
|
Registration Information:
|
Full Name:_________________________________________________________________
Maiden Name:______________________________________________________________
Mailing address: ____________________________________________________________
City:_________________________________ State:_____________ Zip:______________
TTY:__________________________ VP:__________________________
FAX:__________________________ Voice:__________________________
E-mail:___________________________________________________________________
Do you wish to have your name and e-mail listed? Publicly _______ Private ________
|
|
For staff:
|
Year worked from: _____________________ to _____________________
|
|
For Student:
|
Year graduated:_____________________
|
|
Payment:
|
How many people? ____________
(Deadline is on or before June 14, 2021!)
|
1 - $75.00
2 - $150.00
3 - $225.00
4 - $300.00
5 - $375.00
|
Please select Delicious Chicken Menu: California _________ Vegetarian _________
If paying by Check:____ or Money Orders:____, please make payable to "DEAFWORKS".
Note: Due to Check or Money Orders processing time to clear with the bank, the postmarked deadline is on or before June 14, 2021!)
IMPORTANT NOTE: No refunds.
Mail this form to:
SELACO Alumni Association
P.O.Box 1265
Provo, UT 84603-1265
Web: https://www.selaco.org
|
|