150th JUBILEE REGISTRATION FORM
18 – 20
March
2016
Download. Type into form. Save. Email to: [email protected] OR
Print & post to Pokeno School, 54 Pokeno Road, RD 2, Pokeno 2472
Association with the
school.
E.g. pupil, staff, parent
Full Names
Years attended.
E.g. 1977 - 1985
Adult
18+
REG
Child
Up to 17
REG
FRI
SAT
HANGI
SAT
SUN
$20
$20
$20
$20
$20
$20
FREE
FREE
FREE
FREE
FREE
FREE
FREE
FREE
FREE
FREE
FREE
FREE
FREE
FREE
FREE
FREE
FREE
FREE
$45
$45
$45
$45
$45
$45
FREE
FREE
FREE
FREE
FREE
FREE
TOTAL
$$
Flagpole/Garden Contribution OPTIONAL – The Jubilee committee will be restoring the old flagpole, and building a Jubilee garden. Record amount.
OPTIONAL – Please record amount if you would like to make a donation to the school.
Family Donation
Additional reunion booklets can be purchased for $10.00 – Please record number required.
Reunion Booklet Order
Grand Total
MAIN CONTACT
DETAILS
REG
Adult
18+
$20.00
See registration
information page
for details
FULL NAME
REG
Child
Up to 17
FREE
See registration
information page
for details
PHONE
FRI
150th JUBILEE REGISTRATIONS PAYMENT DETAILS:
CLOSE ON
31 JAN 2016
18 March
Mix and Mingle
at Pokeno Hall.
Cash Bar – R18
- 7:00pm -
EMAIL
SAT
HANGI
19 March
Hangi lunch
Pokeno School
- 12:30pm -
ADDRESS
SAT
19 March
BYO Dinner &
Dance Pokeno
Hall. Adults only
- 7pm -
SUN
20 March
Church Service
Pokeno School
- 10am -
☐ Internet Banking – Account Name: Pokeno School Account Number: 12-3453-0035656-00 - Please use main contact name as reference
☐ Cheque – To: Pokeno School – Post or drop in, along with this form to: Pokeno School, 54 Pokeno Road, RD 2, Pokeno 2472