Booker T. Washington High School

Registration Form

Booker T. Washington

Class of 1978 - 50^th Birthday Reunion

June 19th, 2010

Shreveport, Louisiana

Classmate name: _________________________________________________________

Spouse/Guest: __________________________________________________________

Address: _______________________________________________________________

City : __________________________State __________________ Zip _____________

Phone: _____________________ Cell _______________ Wk __________________

(Please type or print clearly)

Planned Activities: (check all applicable)

⁭__ June 19^th - Saturday night dance

__ June 20^th - Church - Zion Baptist Church

⁭__ No events

Fees: $60 - Classmate only (solo)
$85 - Classmate + significant other or NON-classmate

$110 - 2 Classmates (married to each other)

*Note: Fees cover the meal, non-Alcholic drinks, DJ, cake and the facility. Cash bar will be available

Payment Details:

Acceptable payment methods are money order or cashiers check only.

Payable to: BTW Class of 1978

Address:          BTW Class of 1978
                      P.O. Box 38523
        Shreveport, La 71133

Important Dates:

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March 30^th       - ½ payment due

June 16th       - final payment due

June 19^th          - BTW celebrates turning 50- Let’s Party!!!

Note: Please return this form even if you are unable to attend.

Please click here to print a blank form