You Can Also Pay Reunion Fees Online At

2017 EXANTUS FAMILY REUNION PAYMENT FORM

US RESIDENTS Fees US RESIDENTS Fees

BEFORE MARCH 31 st AFTER MARCH 31 st

(Ages 18 and Up) $60.00 (Ages 18 and Up) $75.00 Includes T-Shirt Includes T-Shirt (Ages 7 to 17) $30.00 (Ages 7 to 17) $40.00 Includes T-Shirt Includes T-Shirt (Ages 6 and Under) FREE (Ages 6 and Under) FREE Includes T-Shirt Includes T-Shirt

Please Return Payment Form w/payment to: **ALL PAYMENTS ARE DUE BY July 1, 2017. Nikita Maignan 620 Roselle St. 2nd Floor Linden, NJ 07036

Make check or money order payable to: Nikita Maignan and write “Exantus Family Reunion” in the memo section.

Name:______Address:______City:______State:______Zip______Email:______Phone: ( )______Cell: ( )______

Name(s) (Adults 18 yrs. and Up) T-Shirt -- (Adult) Amount S, M, L, XL Example: John Doe XL $ $ $ $ $ $

Name(s) (Children and Young Adults T-Shirt -- (Youth) XS, S, M, L Amount Ages 7 to 17) (Adult) S, M, L, XL Example: Jane Doe Age: 10 Youth M $ $ $ $ $ Name(s) (Children Ages 6 and Under) Age T-Shirt -- (Youth) Amount XS, S, M, L Example: Jane Doe Age: 5 S $ FREE $ $ $ $ $

TOTAL ENCLOSED $______

You can also pay reunion fees online at: www.exantusfamilyreunion.com