<p> 2017 EXANTUS FAMILY REUNION PAYMENT FORM </p><p>US RESIDENTS Fees US RESIDENTS Fees</p><p>BEFORE MARCH 31 st AFTER MARCH 31 st </p><p>(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</p><p>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</p><p>Make check or money order payable to: Nikita Maignan and write “Exantus Family Reunion” in the memo section.</p><p>Name:______Address:______City:______State:______Zip______Email:______Phone: ( )______Cell: ( )______</p><p>Name(s) (Adults 18 yrs. and Up) T-Shirt -- (Adult) Amount S, M, L, XL Example: John Doe XL $ $ $ $ $ $</p><p>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 $ $ $ $ $</p><p>TOTAL ENCLOSED $______</p><p>You can also pay reunion fees online at: www.exantusfamilyreunion.com</p>