60th Warren-Harris Family Reunion Registration Form

60th Warren-Harris Family Reunion

Registration Form
Head of Household - Contact Person*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number - Home*

Area CodePhone Number
Phone Number - Cell*

Area CodePhone Number
E-mail*
Registration

Please include the name, and indicate the cost and t-shirt size for each person being registered below:
Family Member 1:
Cost:

$50.00 - Senior Adult (ages 70+)$60.00 - Adult (ages 16-69)$30.00 - Youth (ages 6 - 15)Free - Child (ages 0 - 5)
T-Shirt Size
Family Member 2:
Cost:

$50.00 - Senior Adult (ages 70+)$60.00 - Adult (ages 16-69)$30.00 - Youth (ages 6 - 15)Free - Child (ages 0 - 5)
T-Shirt Size
Family Member 3:
Cost:

$50.00 - Senior Adult (ages 70+)$60.00 - Adult (ages 16-69)$30.00 - Youth (ages 6 - 15)Free - Child (ages 0 - 5)
T-Shirt Size
Family Member 4:
Cost:

$50.00 - Senior Adult (ages 70+)$60.00 - Adult (ages 16-69)$30.00 - Youth (ages 6 - 15)Free - Child (ages 0 - 5)
T-Shirt Size
Family Member 5:
Cost:

$50.00 - Senior Adult (ages 70+)$60.00 - Adult (ages 16-69)$30.00 - Youth (ages 6 - 15)Free - Child (ages 0 - 5)
T-Shirt Size
Family Member 6:
Cost:

$50.00 - Senior Adult (ages 70+)$60.00 - Adult (ages 16-69)$30.00 - Youth (ages 6 - 15)Free - Child (ages 0 - 5)
T-Shirt Size
Family Member 7:
Cost:

$50.00 - Senior Adult (ages 70+)$60.00 - Adult (ages 16-69)$30.00 - Youth (ages 6 - 15)Free - Child (ages 0 - 5)
T-Shirt Size
Family Member 8:
Cost:

$50.00 - Senior Adult (ages 70+)$60.00 - Adult (ages 16-69)$30.00 - Youth (ages 6 - 15)Free - Child (ages 0 - 5)
T-Shirt Size
To help with our planning, please indicate if your family will attend the "60th Warren-Harris Family Reunion Banquet" on Friday, July 14, 2023?*
Please indicate any special dietary needs below:
Payment Details

Payment via Zelle: 909-730-7430 / Registered Name: Carol Thomas

Payment via Venmo: @Chenee-McCarter / Registered Name: Chenee McCarter

Please send all checks/money orders payable to:
Carol Thomas, 7100 Gypsum Drive, Jurupa Valley, CA 92509

All registration fees are non-refundable. Thank you for understanding.
Total Amount Due:*
Payment Method*

ZelleVenmoMoney Order/Cash/Check by Mail
For office use only
Payment

PaidNot paid
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60th Warren-Harris Family Reunion

Registration

For office use only