CLASS OF 71
                                     50TH REUNION
                                     REGISTRATION

REGISTRATION FEE IS $50 PER PERSON

STUDENT NAME ___________________________________

ADDRESS  _______________________________________

	 _______________________________________

CITY/STATE/ZIP _________________________________

PHONE# _____________________

EMAIL ___________________________________


NUMBER OF PERSONS ATTENDING  ____  X $50 = $_______


PAYMENT MUST BE REMITTED WITH THIS FORM.

ATTENDEE ______________________________________
NAMES	    
         ______________________________________

         ______________________________________

	 ______________________________________



PLEASE MAKE CHECK OR MONEY ORDER PAYABLE TO SMN71 REUNION

MAIL FORM WITH PAYMENT TO
SMN71 REUNION 
C/O GREG CLEVENGER
16412 W 127TH TER
OLATHE KS 66062