Print out this form and send with check to address below....
Laughlin Reservation Form
February 26 – March 1, 2012
Cost - $ 75.00 per person, $80.00 per person after Jan 1, 2012
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.