Andrea Thompson

Payments must be submitted to Main Street Coffee in dowtown Lake Stevens next to Jay's Market

Mailing payments is not an option at this point. If questions arise please contact Andrea Thompson at

(425) 299-4999

Name: _____________________________________________________________________

Address:____________________________________________________________________

Phone Number:_______________________________________________________________

Email Address:_______________________________________________________________

Total number of guests attending dinner at Club Broadway (max2)____________________

First and Last Name of guest___________________________________________________

Total payment ($30.00 per reunion guest)________________________________________

Please note this information will be used for payment confirmation only.

An email will be sent out once payment is received