Student's Name:

Class Year: 2010 2011 2012 2013 Other

Your name:

Your phone number:

Your email address:

Total number of guests: 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Are any guests Wellesley alumnae? Yes No

Names of all guests (including yourself):

Ages of children attending (leave blank if none):

* The October 3 lunch is free for all students. Each student may bring up to 2 family members at no additional charge. Additional tickets may be purchased for $15 per person.
Total number of additional tickets @ $15 each: Mail checks payable to Wellesley College to: Wellesley College Student Activities, 21 Wellesley College Road, #7326, Wellesley, MA 02481.

If applicable, please indicate if you have dietary restrictions including kosher, halal, gluten free, vegetarian:

If you require special accommodations, please contact James Wice in the Disabilities Office at (781) 283-2434.