Pillers Reunion Registration

Please complete and return the following information, with your check for $5 per person, payable to Susan Burneson. Mail by June 1, 2000, to: Susan Burneson, Pillers Reunion, 1517 Dartmouth Ave., Austin, TX 78757. For more information contact Susan at 512-459-9613 or by e-mail.

Name:

Address:

City/State/Zip:

Area Code/Telephone Number:

E-mail Address:

Please list names of each person attending:
 

Please check the activities you plan to participate in:

If you would like to receive maps or brochures with your registration confirmation, please indicate below (we also will have information available at the picnic on Friday):


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