Please print this form and return it with your menu choice and cheque (£20 each), made payable to The Gowertonian Society to
Mr P Hughes, 2 Tabernacle Terrace, West End, Penclawdd, SA4 3YZ. (Tel. 01792-850014).
(Please note that money is to be sent with order, as no monies will be collected on the night)

Mr./Mrs./Ms./Miss

Surname:______________________________Forename(s)____________________

Address:_____________________________________________________________

_____________________________________ Post Code______________________

Home Tel. No__________________________Work Tel. No.___________________

E-mail________________________________Period in School_________________

Please tick your requirements, or if you are organising a table, the total number required of each course.

Please complete the following:

I am organising a table and would like to book places for _____persons at £20 per person.

They are:

________________ ________________ ________________ ________________

________________ ________________ ________________ ________________

________________ ________________ ________________ ________________

or, I am joining the table organised by: ____________________________________

or, I will join any convenient table. _______________________________________