Please mail this form in its entirety, together with any checks to

Elaine (Landi) Squires, 6 Robert Court, Shoreham, NY 11786

____ I will attend the reunion, together with ____ guest(s)

____ I will not attend the reunion

____ I am including personal information to include in the journal

____ please do not include any of my personal information in the journal

____ please reserve a copy of the journal for me

My personal information

My name (including maiden name):

My spouses name:

My street address:

My city, state, zip code:

My home telephone:

My cell phone:

My Email address:

My kids names (with ages):

What was my occupation?

Who was my employer?

What do I like to do now?

Other comments:

Angie’s Email for reunion questions: angenic@cfl.rr.com
Elaine’s Email for payment questions: esquires@optonline.net