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		KHS Class of 1965. Reunion 2005

If you did not receive your request form from reunion committee please use the form below and mail to: Susan Nagel Bell, 2008 E. McPherson, Kirksville, MO 63501 Ph 660-665-6716

			PLEASE PRINT

	Name (First, Maiden, Last) __________________________________________________________ Spouse's Name ___________________ Your present occupation ___________________________ Email address ______________________________________________________________________ Share email address _____ DO NOT Share email address _____ What has happened in your life since the last reunion ______________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Where were you on Sept. 11? __________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ------------------------------------------------------------------- $ $ $ $ $ $ $ $ $ $ Dinner (Single $30 Couple $50) ------------------- _____________________ Dance (Each $10) --------------------------------- _____________________ T-shirt (L ____ XL_____ $12 ea)---------------- _____________________ Memory Quilt $1 ea / 6-$5 ------------------------- _____________________ Class Update Booklet $6.00 (if not attending) ---- _____________________ TOTAL ----------------- _____________________ PLEASE DO NOT SEND CASH. MAKE CHECKS PAYABLE TO: KHS Class of 1965

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