Reunion 2012 Registration
	First Name* Maiden Name Last Name* Class Year School Stoneleigh-Burnham Mary A. Burnham Stoneleigh-Prospect Hill Address 1* Address 2 City* State* ZIP* Phone* Email* Number of Attendees (Including Yourself) 1 2 3 4 5 6 7 8 Name(s) of Guest(s) Please contact me regarding dietary restrictions No Yes I will need childcare services None Friday Saturday Number of children 0 1 2 3 4 5 Child(ren)'s age(s) Child(ren)'s Name(s) Complimentary Actvities Yes, I will be attending Friday's Wine and Cheese Reception (sponsored by Alumnae Board) Yes, I will be participating in Saturday morning activities (please see schedule) Yes, I will be participating in Saturday afternoon activities (schedule of available activities will be posted as they evolve) On Campus Lodging - $50 per person per night Person 1 (enter number of nights)  @ $50.00 Person 2 (enter number of nights)  @ $50.00 Person 3 (enter number of nights)  @ $50.00 I would like to room WITH I would like to room NEAR Saturday Breakfast  @ $15.00 Saturday Awards Luncheon  @ $30.00 Burnham gathering in Northampton  @ $30.00 Saturday Cocktail Reception & Dinner  @ $50.00 Sunday Breakfast Buffet  @ $15.00 Registration Fee (enter '1' in this field - fee applies to one person per party)*  @ $35.00 Young Alumnae Discount - Class Years 2002 to 2011 Please enter '1' if applicable  @ ($30.00) Form Total: $0.00 Credit Card Information Name on Card* Card Type* Visa American Express Discover Master Card Credit Card Number* Expiration Month* January February March April May June July August September October November December Expiration Year* 2012 2013 2014 2015 2016 2017 2018 2019 2020 CCV*