Print this form, mail it with a check or money order to:
Blossburg-North Penn Alumni Association
86 Morris Run Rd.
Blossburg, PA 16912

# of tickets							Total  
_____	Alumni reunion @ $15 each before July 4		______
_____	Alumni reunion @ $25 each after July 4		______
_____	EMMF concert $20 each 				______
	  $5 Handling fee for concert tickets only	______
		Donation to Blossburg V.I.B.E.		______
		Donation to Alumni Association		______
				Total enclosed  	______
					
Reunion attendees			Class of
(please include maiden name)

______________________________		_________

______________________________		_________

______________________________		_________

______________________________		_________

Mail concert tickets to me at this address:

Name:			______________________________________

Street:			______________________________________

City/State/ZIP:		______________________________________

Email:			______________________________________

Need assistance? Call Steve Gee, 570-662-3933.