Name ______________________Year of graduation** _______

Address ________________________________

         ___________________________________

City ________________________________

State ______________________  Zip Code __________

Email (optional) ________________________________

Phone (optional) ________________________________
(one or the other of the above would help us get in touch if there are plan changes)

Number planning to attend _______________

Enclosed is a check for _______ ($50 for each person)
Checks can be made out to Dianne Brainerd

and mailed to:
Dianne D. Brainerd
34 Shunpike Road
Suite 3, PMB 245
Cromwell, Ct. 06416-2453

**or year you would have graduated from CHS

Please return by June 1, 2006