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Return This Form by April 15, 2010




(Please Print)


Name _______________________________________________________________________________

First Last Maiden


Address _____________________________________________________________________________

Street Phone


City State Zip Code


E-Mail address _______________________________________________________________________


Spouse Name (If applicable) ____________________________________


Make checks payable to Northridge Class of 1965. Send your check and return this form by April 15, 2010 to: If you wish to donate additional funds toward our reunion expenses, any amount would be appreciated.

Note: If you have fallen on hard times and want to attend, but cannot afford to pay please call me and it will be kept confidential.

Ruthellen (Kelley) Gunning

633 W. Broadway St

Tipp City OH 45371

937-667-8272 or 937-760-8383 (mobile)


Please indicate what events you would like to participate in

Friday Evening Pizza Buy Your Own _______ How Many?

Saturday Breakfast Buy You Own _______ How Many?

Saturday Evening $25.00 Per Person _______ How Many?


If you need hotel reservations please consider these options:


Dayton Airport Inn

7575 Poe Ave (Next door to Celebrations II)

Dayton, OH 45414

937-454-0550 Ask for Natasha Cox and tell her you are with the Northridge Class of 65

Price is $59.99 per night (includes continental breakfast) Handicap rooms available

We have 10 rooms blocked; Reservations must be made by April 25, 2010.






If you have questions, feel free to call Ruthellen (Kelley) Gunning at 937-667-8272 or Penny (Winterbotham) Miller at 937-898-7701