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2018 Mom Prom Reservation Form
Bring some warmth to January - Attend the 2018 Mom Prom!
Saturday, January 27, 2018
The Courtyard by Marriott, Hamilton
7:30 -11:00 PM
Register to attend the 2018 Mom Prom! Come dressed in your favorite Hawaiian clothing!

If you are attending with more than one son, please add their name on question #3.
Charges are $50/couple, $15 extra son/person which includes appetizers, desserts, drinks, DJ and dance lessons for the evening. Payments will be made through FACTS.

Email address *
Student #1 LAST NAME *
Your answer
Student #1 FIRST NAME *
Son #1
Your answer
Student #2 FIRST NAME
Son #2, if applicable
Your answer
Mother's full name *
Your answer
Mother's phone number *
Please provide a current phone number
Your answer
Mother's email address *
Please provide a current email address
Your answer
Thanks for your reservation! We are excited you will attend!
Upon clicking SUBMIT, your reservation will be made for the 2018 Mom Prom.
By submitting your reservation, you agree to pay the $50.00 fee for Mom Prom via FACTS (and $15 for an additional person, if applicable). A confirmation email will be sent to the address provided.
Questions? Contact Angie Gray - or Gina Helms -
A copy of your responses will be emailed to the address you provided.
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