2024 Harrisonites Reunion Pre-Registration
Last Registration Day - July 15, 2024 without $10.00 penalty!
Attendee Information
Mail your Check or Money order payable to Harrisonitesinc,Inc, to PO Box 2093,Blytheville AR 72316. $150.00 Per Harrisonite, $100.00 Per Guest. Upon completion of the form click the "SUBMIT" button at the bottom of the form. Each Harrisonite should complete an individual form. Submit the first form and return to the link to create and submit another. Last pre registration date, July 15, 2024. If you miss this date a $10.00 late fee will be charged. If you have difficulty with the form contact Kenneth King: 870-740-1194. When I Receive your Check or MO, I will post it on the website under the "Commitment Tab" it will be in Pink background.
First, Middle, Last Name (Ladies how do you want your name tag to read?)
*
Your Class Year
Email Address
example@example.com
CELL Phone #
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Optional $10.00 scholarship donation
Yes
No
If more than $10.00 indicate amount
Are you or were you in the medical profession/First Responder/Home Health Care/Medical related clerical duties?
Yes
No
Will you have a guest with you?
Yes
No
Guest Names necessary for Name Tags
Please Enter the Name of your Guest, if its your spouse or significant other! All other names should go in the designated areas below!
Name
First Name
Last Name
Name
First Name
Last Name
Name
First Name
Last Name
Name
First Name
Last Name
Name
First Name
Last Name
Submit
Should be Empty: