Brunskill - The Wonder Years Reunion
First
Name: _______________ Maiden Name:
_______________
Surname:
_________________ At Brunskill from 195__ to 195__
Mailing Address: ________________________________________
City:_________________________Prov/State:________________
Postal / Zip Code:___________
Country: ____________________
Email address:__________________________________________
Phone: ( ) _____-______ (H) Phone: ( ) _____-_______(W)
Guest:________________________________________________
Attending FULL
WEEKEND: # _____x Cost $100 = $________
Attending ONLY SAT DINNER # ____ x Cost $40 = $_________
Full Payment made by:
__ check __money
order for $ _______
Partial Payment made by: __ check __
money order for $_____
-------------- Remaining payment due May 31, 2004 -----------
I/we will need transportation in the bus for ____ persons
Make payment to 'Brunskill The Wonder Years' and mail to:
Mrs. Cheryl Lejbak Email:
cheryllejbak@yahoo.com
#120 835 Heritage Green
Saskatoon SK S7H
5S5
Phone: (306) 249-3171