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Due by January 7th

Name - ___________________________________________

Address - _________________________________________

Dates (calendar yrs.) with the basketball program -_______

Jersey Number - ___________________________________

Role (Player, Coach, Trainer, etc.) - ___________________

Guest Name - _____________________________________

Email Address -____________________________________

Phone Number -___________________________________

Names of Additional Family Members Attending:

Please register ASAP. After January 7, 2011 registrations will be accepted on a space available basis.

A registration fee of $25 will be assessed to each registrant (player, manager, coach, etc.). This fee will cover each registrant, guest, & family members for all reunion events + two complementary tickets to the UL-M game Saturday. Additional game tickets are available at $8 each to those in your family beyond the one guest. In view of the modest registration fee, please consider making a donation or being a reunion sponsor to help defray the costs of a wonderful weekend.

Reunion Registration Fee


Extra tickets @ $8 ea.

_____ x $8 =






Please complete this form and mail to UL Men's Basketball Reunion, 201 Reinhardt Dr., Lafayette, LA 70506. Checks should be made out to Men's Basketball Reunion. If you are paying by credit card, please provide the following information:

Type card _____ Credit Card Number ______________Exp. Date _____

Name on card:(Print)_______________Signature__________________

Total Amount to be charged

Registration information will be posted at www.athleticnetwork.net as soon as each registration is processed. To view the names of all registrants, click on Photo Gallery, M Basketball, the 2011 Reunion link, and the Advanced Registration link.

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