Patterson-Smith Reunion Registration Form

Instructions: Please fill in the blanks and/or circle your responses.

Required Information

Your Full Name:

Nickname:

Spouse:

Street Address:

City:

State:

Home Telephone:

Work#:

Zip Code:

Are You Attending the Reunion?:

Yes No

T-Shirt Size: S M L XL XXL

Is Your Spouse Attending the Reunion?:

Yes No

T-Shirt Size: S M L XL XXL

Your Children

1. Child's Name:

Date of Birth:

Attending Reunion?:

Yes No

T-Shirt Size: S M L XL XXL

2. Child's Name:

Date of Birth:

Attending Reunion?:

Yes No

T-Shirt Size: S M L XL XXL

3. Child's Name:

Date of Birth:

Attending Reunion?:

Yes No

T-Shirt Size: S M L XL XXL

4. Child's Name:

Date of Birth:

Attending Reunion?:

Yes No

T-Shirt Size: S M L XL XXL

5. Child's Name:

Date of Birth:

Attending Reunion?:

Yes No

T-Shirt Size: S M L XL XXL

History Information

Mother's Maiden Name:

Mother's Birthdate:

Mother's Birthplace:

Father's Name:

Father's Birthdate:

Father's Birthplace:

Your Birthdate:

Your Place of Birth:

What Will You Volunteer For? (Circle All That Apply):

Driving

Photography

Chaperone

Choir

Family Locator

Web Design

Printing

Banquet Speaker

DJ

LifeGuard

BabySitter

Lead Games

Make Calls

Banquet Usher

Contribute News Articles

Musician

Other: (Please Explain)

I Would Like to take the Heritage Tour:

(Note:There is a separate charge for the tour but we should get a group discount.)

Yes No

Comments:

Thank you for returning your registration form promptly! Return your form to:

Chicago Patterson-Smith Reunion

2S.685 Summerfield Court

Wheaton, IL 60187