Lewisburg Area High School Alumni Weekend 2016 October 7-9 Registration Form
Include payment and return by October 1 (See other side for events) Participant Information: (Please PRINT clearly) Name: _____________________________________ Maiden Name, if applicable:____________________ Class of _____________ Preferred Name for Name Tag (First and Last): ___________________________________________
Home Address: _____________________________________
L e Guest Name: __________________________________________ w i Maiden Name, if applicable:______________________________ s If LAHS grad, class of ____________________________________ b u Guest(s) Preferred Name(s) for Name Tag (First and Last): r g _______________________________________________________ , P A Home Phone: ____________________________________
City/State/Zip:______________________________________
1 Cell Phone: ______________________________________ 7 E-mail Address: _____________________________________ Emergency Contact Phone:8_________________________ 3 7 Phone (570) 522-8433 To Register:
EITHER: Go online to: http://tinyurl.com/awlahs2016 OR: Follow these steps: 1 – Please select each event in which you want to participate, 2 – Calculate the total amount due, and 3 – Send in your check with this registration form. Mail form and check by October 1st to:
LAHS Alumni Weekend 115 Farley Circle, Suite 306 Lewisburg, PA 17837 Phone: (570) 713-8427 *On-Line Registration visit: http://tinyurl.com/awlahs2016
Event tickets, welcome pack, and all weekend materials must be picked up prior to your 1st scheduled event at the Alumni Weekend Registration Table located at field behind LAHS. Registration Table Hours: Friday, Oct. 7: 12:00pm to 4:00pm and Saturday, Oct.8: 9:00am to Noon
Application release and indemnity form: In consideration of the acceptance of the LAHS Alumni Weekend 2016 Registration Form, I waive all claims for myself, my heirs and assigns against the sponsors, cooperating and coordinating groups, and any individual associated with the weekend events and will hold them harmless for any and all injuries or illness which may result from my participation. I further state that I am in proper physical condition to participate in the events for which I registered.
Registrant 1 Signature: _______________________________ Date: _____________________________________________
Registrant 2 Signature: ______________________________ Date: ____________________________________________
Need a hotel reservation? Visit http://www.greendragonfoundation.org/1204/all-alumni-weekend/ for more info.
Alumni Weekend 2016 REGISTRATION FORM - PAGE 2 Events: Friday, October 7, 2016 “Fire Breathing Dragon Tailgate Pit!” 5:00pm -7:00pm at Bucknell Stadium Upper Parking Lot Football Game vs. Danville at Bucknell’s Christy Mathewson Stadium at 7:00pm It’s OK to go Spastic…Post Game Gathering at the Bull Run Tap House Post – Game Celebration at Brendan’s Towne Tavern in the Shanty
# of People
Price for event per person $7.00 each
Total for event $
$5.00 each
$
$6.00 each Cash Bar Appetizers provided with Cash Bar
$
Events: Saturday, October 8, 2016 Tours of Lewisburg Area High School start at Cafeteria: 10:00, 10:45 and 11:30 a.m. Alumni Golf Outing – Tee Times starting at 11:00 a.m. Bucknell Golf Club
# of People
Price for event per person No cost: Please circle preferred tour time 10:00 a.m. 10:45 a.m. 11:30 a.m. $35.00 - members of Bucknell Golf Club $65.00 - non-members of BU Golf Club
Total for event No Cost
History of Lewisburg Walking Tour at 1:00pm
No Cost
No Cost
Wine Tasting at Fero Vineyards –2:00pm - 4:00pm
Pay at event
$
Lewisburg Alumni Cocktail Reception 4:30 pm -7:00 pm at Country Cupboard (Casual Attire)
No Cost
No Cost
Price for event per person Payable at event (15% gratuity will be added to all bills)
Total for event
Events: Sunday, October 9, 2016 Farewell Breakfast Buffet at Country Cupboard – 9:00am-10:30am
# of People
No Cost
$
Total for All Events – Please be sure to add $ right column from each event $ *Donation to help with event costs Total amount remitted $ ________________________________________________________________________________________________________________________ For Office Use Only: Date Received: ________________ Total Amount Due: ____________ Amount Paid: ________________
Check #: ____________________ Waiver Signed: ______________ Confirmation Sent: ___________
DD Software Entry: ___________ Excel Events: ________________ Excel Payments: _____________
