Name ______________________________________               Phone___________________

 Address_______________________________________________________________________

 City______________________ State____________ Zip______________

E-mail_______________________________________________________

I / We enclose $____________ for ________  @ $20 each (before 3/31/12)/-------  $23 each AT THE DOOR  for the Friday Welcome Dance.

I / We enclose $____________ for ________  @ $20 each (before 3/31/12) ------/ $23 each AT THE DOOR  for the Saturday Ball.

TOTAL            $______________

 Return this form to: Eilean D. Yates, 1223 New Crest Lane, Shelby, NC 28150-9782--------PLEASE MAKE CHECKS  PAYABLE TO EILEAN D YATES