Jefferson High School Class of 1974 Dinner and Reunion Reservation Form

Nicholas Conservatory & Gardens
1354 North Second Street, Rockford, Illinois, 61107

Saturday, August 16, 2014
Time: Cocktails & Sign-in 6:00-7:00p.m.
Dinner and Fellowship 7:00 to 10:00p.m.

Admission: $37.50 each • $75.00 per couple

Reservation Form
Full name of each attendee
First Attendee
Second Attendee

Third Attendee
Fourth Attendee
Total X $37.50

Name of person making payment
First Name

Maiden Name

Married or Last Name

Home Address

Home City
Home State
Home ZIP

Home Country
Home Phone
Cell Phone
Email

Write Check for full amount to: "Jefferson High School Class of 74"

Please print form and mail to:
Jefferson Class Reunion c/o
Kevin Nousianen
1238 Key West Drive
Rockford, IL 61103

For questions or special arrangements (including dietary), please contact Kevin at (815) 289-5713
or email at kevin.nousianen@gmail.com.

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