On-Line Registration Form

Your FIRST NAME - Maiden (if applicable) - Last Name *

First

Middle

Last

YEAR GRADUATED from BVHS *

SPOUSE'S First Name - Maiden (if a BV Grad) - Last Name

First

Middle

Last

YEAR GRADUATED (if from BVHS)

MAILING ADDRESS: Po Box or street *

CITY, ................................ STATE, ................... ZIP CODE *

First

Middle

Last

EMAIL *

Donating a DESSERT to the auction?

Do you have someone you would like to add to the MEMORIAL BOOK?

Memorial Name and Year Graduated:

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