Adult Assessments $99.00

Name of Family Member:

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CHILDREN  1-5 FREE

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Total Assessment Amount:_______________

T-Shirts:  Adults  $12.00      #_____ &   size__________

               Children $10.00     #_____ &  size__________

Total T-Shirt Amount:_____________


Total assessment and T-shirt  amount enclosed:_______________

Make check or money order payable to: LAWRENCE SPRUILL REUNION LA.

Mail payments as soon as possible to:

Inoler H. Brown
19402 Belshaw Ave.
Carson, CA 90746