To make payment, please complete this form, print it and send it with your check or money order, made payable ONLY to Donald Sweeney
12 Beech Street
P.O. Box 817
Point Lookout, New York 11569

Personal Information
Name At Graduation: Last First
Married Name:

City: State: Zip:
Email Address:
To Confirm Your attendance please send a Deposit of $50.00 per person.
Number Attending - Please check the Appropriate Box
Solo: With Partner: Partners Name:
Amount Enclosed :
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