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  5. Reunion55 Survey#2
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Questions marked with an * are required Exit Survey
 
 
* First Name : 
* MAIDEN & Last Name : 
* Address 1 : 
   Address 2 : 
* City : 
* State : 
* Zip : 
* Phone : 
Email Address : 
 
 
 
Do you have a cell phone?
 
No
 
Yes, Cell #
 
 
 
 
What is your date of birth?
 
 
Partner:
First Name : 
Last Name, if different : 
 
 
 
* Will you be attending REUNION55 in September 2014?
 
Yes
 
No
 
 
 
How many will be attending?
 
One
 
Two
 
 
 
Which events will you be attending? (we're hoping you'll say all!)
It is imperative that we have a head count for all events.
 
FRIDAY @ The Copper Cup (cash bar)
 
SATURDAY Lunch @ Rustic's (price not included in weekend package)
 
SATURDAY evening @ The Legacy at Sweetbriar (cash bar)
 
SUNDAY Brunch @ Houlihans (price not included in weekend package)

 
 
 
Legacy dinner choices- enter number in box corresponding to your meal choice(s). If you need a special request for health reasons, place it in 'special meal' and we will attempt to accommodate you.
Bacon-wrapped Filets
Asiago Pork Schnitzel
Lake Erie Perch
special meal
 
 
 
* Can you email (or mail) a recent color photo of yourself for the Directory?
(please, no sunglasses, hats, etc.)
If you can't send a photo, we will be forced to use whatever we can find. If mailing, we will return your photo via US mail.
 
Yes
 
No
 
 
 
Please check off additional items you would like to have.
(all items will come via US mail to your home.)
 
Extra Directory @ $5.00
 
Friday Nite Class Photo @ $3.00
 
Saturday Nite Class Photo @ $3.00

 
Press CONTINUE, to send your application. We look forward to seeing you in September!