Contact information
First name
Last name
Dates Attended Harmony
Home information	Street City State Zip Phone
Cell phone
Email
Websites, Myspace, Etc.
Event & Billing information
Weekend Package includes Friday night meal, Saturday reception and party, and Sunday brunch, two drink tickets, and one free tee-shirt (please indicate size). children 12 and under FREE Individual $50 Couple $75 Family $100 Other I’m interested in other payment options. be sure to include your contact information! T-Shirt Size: none Small Medium Large XLarge
If you selected Couple or Family Packages, please list partner and family attendees below: Name Relationship to you
Payment Options Check/Invoice Make checks payable to Harmony School and mail to: Harmony School, PO Box 1787, Bloomington, IN 47402 Please enter billing information below Credit card To pay with credit card, please follow the link to pay after you have submitted this form or call the NSRF National Center at 812.330.2702 to pay by phone. If payment is not received within two weeks of registration form submission, we will invoice you at the address specified below.
Billing address	Home address previously entered Other billing address (please enter billing address below)
Other billing address	Billing contact: Street City State Zip
Billing phone (include area code)
Additonal Contribution	Your added contribution helps underwrite the costs of the reunion. We appreciate your support. Please enter your additonal contribution to the Harmony School Reunion: $ If you have any questions about reunion sponsorship or other types of giving, please contact Mary Beth Roska, our giving officer at mbroska@harmonyeducationcenter.org or 812.334.8379.