***If paying by check please complete the following information and mail it in with your check.

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Name _____________________________ Age (prior to 10/15/2025) __________ Male or Female
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Year of Graduation from High School _______________ T-Shirt size ____________
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Address _____________________________
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City ____________________ State ____________ Zip __________________
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Primary Phone: ______________________ Secondary Phone ____________________
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Contact email: ________________________________