HUTTO-BISHOP 2018 FAMILY REUNION PAYMENT FORM
/ Fees
Adults (Ages 18 to 74) / $87.00 – Includes T-Shirt
Senior Adults (Age 75+) / $67.00 – Includes T-Shirt
Teenagers (Ages 13 to 17) / $57.00 – Includes T-Shirt
Youth (Ages 6 to 12) / $47.00 – Includes T-Shirt
Children (Ages 5 and Under) / Free
Please return Payment Form w/payment to:
Inels T Williams
750 Irish Rose Road
St Augustine, FL 32092
Make check or money order payable to: Inels T Williams and write “Hutto-Bishop Family Reunion” in the “memo/for” section bottom left of your check. / **All payments are due byJune 30, 2017. Any payments received after this date must include an additional $10.00 Per Person Fee to cover costs incurred from vendors for last minute changes. TO AVOID THESE ADDITIONAL FEES, BE SURE THAT YOUR PAYMENT IS MADE BY June 30, 2018**
Primary Contact Name:______
Address:______
City:______State:______Zip______
Email:______
Phone: ( )______Cell: ( )______
Name(s) (Adults 18 to 74) - Include Yourself / T-Shirt---(Adult)
S, M, L, XL, 2XL, 3XL, 4XL / Amount
Example: John Doe / XL / $ 87.00
$
$
$
$
$
Name(s) (Senior Ages 75+) / T-Shirt- (Senior)
(Adult) S, M, L, XL, 2XL, 3XL, 4XL / Amount
Example: Jane Doe / M - Youth / $ 67.00
$
$
$
$
$
Name(s) (Teenagers Ages 13 - 17) / T-Shirt---(Youth) XS, S, M, L
(Adult) S, M, L, XL, 2XL, 3XL, 4XL / Amount
Example: Jane Doe / S / $ 57.00
$
$
$
$
$
Name(s) (Youth Ages 6 – 12) / T-Shirt---(Youth)
XS, S, M, L / Amount
Example: Jane Doe / S / $ 47.00
$
$
$
$
$
Name(s) (Ages 5 and under)
Example: Jane Doe
TOTAL ENCLOSED $______
Group Tour Participants (See Information Sheet for Costs)
Name of Attendee(s) / Yes / No / Age / Amt Paid