PLEASE RETURN THIS FORM WITH PAYMENT AND THE INFORMATION FORM BY JULY 1, 2005 TO:

BOB SMARZINSKI
904 ELMWOOD DRIVE
MENASHA, WI 54952

MAKE PAYMENT PAYABLE TO: CLASS FUND MHS 1965

Name:_______________________________________________________

Address:______________________________________________________

_____________________________________________________________

Phone number:_________________________________________________

E-mail address:_________________________________________________


___ Sorry, I can't attend but please keep me on the mailing list.

___ Sorry, I can't attend but please send a Class Address Booklet. $ 5.00

___ I/we will be attending the class reunion.

Number of people attending ____ X $35.00 per person $________

___ I/we will be participating in the golf outing.
Number of people participating ___ X $30.00 per person $________

TOTAL $________

Please take a minute to fill out the enclosed form that we will include in the
Class Booklet.

YOUR NAME:_________________________________________________
(include maiden name)

SPOUSE'S NAME:______________________________________________


ADDRESS:_____________________________________________________


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COMMENTS:____________________________________________________


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