8/9/2019 Class of 74 Reunion Registration

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8/9/2019 Class of 74 Reunion Registration

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To have a memory book mailed to you please add $5.00 shipping and handling per book.

Please fill out and return by Jun 1, 2010 so well have time to compile the

memory books that will be available at the event. Make checks payable to:

Jefferson Class of 74 and send to: Jefferson Class of 74 c/o Amy J. Dean 1544

5th Ave. S.E. Cedar Rapids, IA 52403-1219

Please include maiden and married name if it applies

Name: _______________________________________________________

Spouse or significant others name: ______________________________ Years married:

__________

Address: ________________________________________________________

_________________________________________________________________

Phone: ______________________ E-mail: _____________________________

Children names and ages: _____________________________________

______________________________________________________________________________

______________________________________________________________________________

Grandchildren: ________________________________________________

______________________________________________________________________________

_____________________________________________________________________________ _

Work: ________________________________________________________________________

______________________________________________________________________________

Hobbies/ Interests: __________________________________________

__________________________________________________________________

_______________________________________________________________

8/9/2019 Class of 74 Reunion Registration

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Anything else you want to share (use back if needed):