* = required field
Which School?
BHS CHRS
Name (include maiden name)
Phone*
Ok to post my mailing address
Mailing address* (Street / PO Box)
City*
State*
Zip*
E-mail address*
Family Information
Occupation
Hobbies/Interests
Names of any deceased classmates to list on a memorial page in the program
Names or addresses of other class members
Name
How many people?
# Will attend # Will not attend $48.00 per/person
Choice of Dinner ( Please check the following)
Broiled Stuffed Flounder Filet with Crabmeat and Shrimp Stuffing with Lemon Butter Glaze
Roasted Lobster and Chicken Breast with Lobster Butter
Slow Roasted Prime Rib with Natural Pan Jus
Vegetarian Entrée by special request
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