Reservation Form For 12/10/11 Holiday Party

Reservations must be made by 12/03/2011

Each person needs to bring 2 cans of food or a cash donation at the door.  This will be given to the Salvation Army

Name of person(s) attending Adult/Teenager Child (5-12) Child (4 and under)

Number of People

   Number of Adults at $16.00 each = 
   Number of Children ages 5 to 12 at $8.00 each = 

   Number of Children age 4 and younger at $0.00 each = 

                      Enclosed is my check for $

MAKE CHECKS PAYABLE TO PENN STATE CLUB OF NORTH TEXAS

MAIL TO: Judy Micklow (address can be found in the NTPSU directory)

or send an e-mail to: psu.club@verizon.net for address info