***Right click on the form below to print***

REGISTRATION FORM

COMPLETE AND RETURN THE REGISTRATION FORM BY:           July 1, 2019

MAKE CHECK ($22.00*- per person)               Payable to:  BUSHTON ALUMNI ASSOC

Mail Completed Registration Form To:
BETTY DOHRMAN                   601 SOUTH 2nd STREET             BUSHTON, KANSAS   67427
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NAME_______________________________________________________        CLASS YEAR______

ADDRESS____________________________________________________       # OF TICKETS_____

TELEPHONE #______________________ E-MAIL ADDRESS_______________________________

GUEST(s)(no limit)______________________________________________ $$ ENCLOSED________

I AM INCLUDING A DONATION FOR THE SCHOLARSHIP FUND FOR:     $$__________________

"EXCEPTIONAL DIETARY REQUEST" (ie, vegetarian)_____________________________

*- ENTREE:: Baked Steak, potatoes, vegetable, salad, rolls, Tea/Water
subject to change as reunion date approaches (3/1/19)