The 21st Biennial
Jackson~Dailey Family Reunion 2018
Fort Lauderdale, Florida
Family Member Name: _________________________________________________________________
Family Branch Connection: ______________________________________________________________
Address: _____________________________________________________________________________
Phone Number: _______________________________________________________________________
E-mail Address: _______________________________________________________________________
___________ I will attend ___________ I will not attend
Names of Attending Family Members & Friends
Adults: (Ages 18 & Older) Youth: (Ages 17 & Under) Age T-Shirt Sizes
(If Applicable)
***If additional space is needed for names, please feel free to include an additional sheet of paper with names.
Number of Adults (18+) ___________ x $100.00 = ___________
Number of Youth (13-17) ___________ x $80.00 = ___________
Number of Youth (4-12) ___________ x $50 = ___________
Number of Youth (0-3) ___________ x $0 = ___________
Number of T-Shirts (S, M, L) ___________ x $10 = ___________
Number of T-Shirts (XL to 3XL) ___________ x $12 = ___________
Total: _____________________
Submit All Payments to: William T. Jackson
Jackson~Dailey Family Reunion 2018
P.O. Box 1282
Fort Lauderdale, Florida 33302