Dinner and Dance Reservation

Alumni Name:

Guest Name:

# of Reservations

x $50.00 per person = Total Amount Due of $

RESERVATIONS AND PAYMENT MUST BE  RECEIVED BY  MAY 1, 2012

Please print page and mail with your check payable to “Class of 1972 Reunion”.

Mail to:

LSHS Class of ‘72
P.O. Box 1972
Lee’s Summit, MO  64063

[Dinner/Dance]