Registration Form

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Registration Form

Classmate attending: __________________________________________________________________

(first, middle, maiden, and last names)

Mailing address: ___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

E-mail address: ____________________________________________________________________

Best telephone number: ______________________________________________________________

Year of graduation/attendance: _________

Guest: ____________________________________

** Note: If your guest attended Smithfield-Selma, please attaché a separate completed registration form.

Thank you!!