Registration Form

Registration Form – Fill out PLEASE. Email it to centralhs71@gmail.com  or send it by mail to Kristi

Payment Methods

1)     Send your check to Kristi Lee Neerman In the memo area of your check, write CHS ’71 Reunion.

• Use www.paypal.com and with our code: centralhs71@gmail.com. If using PayPal, add $ 2.00 for PP fee.

Send Registration and/or Payment to:
Kristi Lee Neerman
2619 W Boston Pl
Broken Arrow, OK  74012

 

Questions please call 469-688-1900 or 918-760-1707 
or email at centralhs71@gmail.com

                                                  Email or Send This Form to us!

First Name:                             ___________________________________  
Last Name:                             ___________________________________
Maiden Name:                        ___________________________________    
Spouse/Guest name:               ___________________________________ 
HS Class:                                ______________
Total # attending:                   _______

Address:                                         ____________________________________________________
                                                      ____________________________________________________
                                                      ____________________________________________________
Email:                                             ____________________________________________________
Phone:                                           ____________________________________________________

Please enter number of people attending:
 
Friday Only                                 _______ @ 15.00    = _______________
Saturday Tour and Lunch             _______ @ 10.00    = _______________
Saturday Night                            _______ @ 40.00    = _______________

All Events                                   _______ @ 45.00   =  _______________

                                                                   Total Due: _______________

* If you are unable to attend, please consider creating a short, 1 minute, video about where you are living and 

what you have been up to since High School.  

We would love to hear from you.  We will use your video Saturday evening in our program. 

Send your video to centralhs71@gmail.com

!!! Make sure we have your current email address, home address and phone number !!!