DJS 75th Diamond Jubilee Registration

DJS 75th Registration

Print and Mail by

Deadline April 15, 2014

Registration fee is $30 for adults and $15 for children under 18  

 

 

Name _________________________________________________________________________

 

Address _______________________________________________________________________

 

City, State, Zip ___________________________________________________________________

 

Telephone ______________________________________________________________________

 

E-mail _________________________________________________________________________

 

 

Names of Adults Attending

 

    ____________________________________________________________________________

 

    ____________________________________________________________________________

 

Names of Children Attending

 

    ____________________________________________________________________________

 

    ____________________________________________________________________________

   

 

Adults        $30 x _______ (attendees) =  ________

   

Children     $15 x  _______ (attendees) = ________

                    

                                               Total Enclosed  ________

 

Mail to:   Gary O'Neal

1833 Wheeler Drive

Natchez, MS  39120