PLEASANT HILL HIGH SCHOOL HALL OF FAME

REGISTRATIONS FORM

First Name

Last Name

City State Zip

Phone Number

Number of Guests

Names of Guests

Address

Payment Method

Credit Card

Credit Card Information

Credit Card Number:

CVV (3 Digit Security Code) or (4 Digit Security Code for American Express Card):

Expiration (MM/YY):

Zip Code:

Cost per person is $130 by Credit Card

If you want to Pay by check the cost is $125 per person, checks can be sent to PHHS Hall of Fame, 499 Camino Las Juntas, Pleasant Hill, CA 94523