Name:

Street Address:

City, State Zip Code              

Main Contact #

Alternate Contact # (if applicable)

Email address:

Do you plan to participate in this year's activities?

Yes    No

Which activity do you plan to attend? Check all that apply.

Fish Fry/ 70's Night Saturday, December 18, 2004

Worship Service & Dinner Sunday, December 19, 2004

Bonfire/ Cookout Tuesday, December 21, 2004

Reunion Dance Thursday, December 23, 2004

How do prefer to be contacted regarding this application?

Email    Phone    No preference

 

Please add any additional notes that you would like to include with your application.

Note: We will gather biographical info at a later date.

Click the button below to submit this application.  Once application is submitted, you will need to send a check or money order for member dues to the address below. 

Class of 1974

1743 NE 39th Street

Ocala, Florida 34479

Make payable to: Class of 1974