Middletown High School Class of 1969 50th Reunion

Friday, June 28, 2019 Ice Breaker at Olde Erie Restaurant
Saturday, June 29, 2019 Dinner Dance at West Hills Country Club

Please fill out and return this form with your check payable to "MHS Class of '69" to:
Lynn Racine, 25 Watkins Ave, Middletown, NY 10940
___ I will be attending both Friday and Saturday events ($95 per person in advance)
_ I will be attending only the Friday Ice Breaker ($20 per person in advance)
_ I will be attending only the Saturday Dinner Dance ($75 per person in advance)
___ Unfortunately I will not be able to attend either event

ADDRESS INFORMATION

Name: ________________________________________________________

Address: ______________________________________________________

City: ______________________________ State: _____ Zip: ____________

Telephone: (____) ____ - ________

Email address:________________________________________________________________

Are you on Facebook or other social media website? _____ Yes _____ No

Do you have a web page which we can link to? _____ Yes _____ No
Page Name (if Yes): ________________________________

We will not be publishing a booklet this year, but we may circulate address information among the class. If you do not
want your address passed on to anyone, please check here: _____

Interesting information about you and your family that you would like to share:

______________________________________________________________________________________________