2019REUNIONREGISTRATION

PRINT THIS FORM, FILL IT OUT AND SEND IT TO:

The Survivors c/o Karen DeWall

3979 Bridle Path Loop,

Pinetop, AZ 85935

Yes, I'll be attending the Media and Advertising Survivors Annual Reunion, Saturday,

April 18, 2020, 12 Noon, at the University Club of Phoenix

List yourself and those attending with you.

Name____________________________________________

Enclose a check to The Survivors for a total of $25 times the number of your attendees.

Thank you, and we look forward to seeing you!!

To keep our records up to date for future contact, please give us your current information. (We never share this with anyone)

Name_______________________________________________

Address_____________________________________________

City____________________State________Zip______________

e-mail address:________________________________________