SSU–Class of 1976 45th Reunion Registration Form--Due on or before September 15.

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Email *

Complete Name (Include maiden name) *

Telephone/ Cell # *

Home Address *

Please check all included in the submission. *

Pledge amount of my choice. ($450 minimum requested.)

Registration Only @ $50 each

Guest fees @$20 each (Celebration reception only)

SSU Class of 1976 Polo Shirt, $35 each

I am unable to attend homecoming and reunion activities, but I will make a donation.

Required

T- Shirt Sizes-Male/Female (S, M, L, XL, 2XL, 3XL $35 Each *

2XL

3XL

No shirt, thank you.

Required

Select size: SSU Class of 1976 Windbreaker Jacket (class gift) Included in full registration fees; not for guests. XS S M L XL XXL 3XL 4XL Size 12/14 16/18 20/22 Bust/Chest 39-41 42-44 45-47

XXL

Clear selection

I plan to send payment by Sept. 15th via *

PayPal

Check in USPS Mail. Return to Mr. Willie Roberson, PO Box 2797, Washington, DC 20013

Credit Card

My total payment due is in the amount of *

Comments or explanation for committee

Send me a copy of my responses.

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