REGISTRATION FORM

(Print and send to:
Tina Barnett      tinabarnett8@gmail.com     Mobile: 027 5266 281)

Surname …………………………………..…………………………….……………..

First name …………………………………..……………………….………………..

Maiden name? ……………………………………………………………..…………

Accompanying Partner/Caregiver? ………………………………………………………………..

Address …………………………..…………………………………..………………………………………..
……………………………………………………………………………………………………………………..

Email ………………………………………………….………………………………..      
Phone …………………………………………………………..……………………..

Any special dietary requirements?
………………………………………………….….……………………………………………………………….
………………………………………………………………………………………………………………………


REGISTRATION / REUNION PAYMENT  ($80 per person)

Bank Account Name:  Ardmore Reunion
Bank Account Number:   ASB – 12 3118 0527426 50
(NOTE: Please include your name as reference)

Registrations close Friday 14 October 2022
(Please register early for catering purposes)