Online Registration

Online Registration

Full Name *

Address *

City *

State * Select one Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code *

Phone Number *

E-mail Address *

Name of Adult (s) (age 14 - 70 & Older) -$50 per person (8/15 - 11/16/24): *

Name of Child(ren)- (age 3-13) $20.00 per person (8/15 - 11/16/24): *

Submit Name (s) of Children Under 3 ( No Reunion Fee, ONLY payment for T-shirt (s) *

Please Check Your Burch Family Lineage: *

Brewster Burch

Bartley Burch

Clessie Burch

Cleo Burch Holmes

Jethro Burch

Lemuel Burch

Dan Burch

Leila Burch Bostick

Monroe Burch

Charlie Burch

Frank (Hollis) Burch

T-shirt Size (s) plus Fee(s) =$10 Per Shirt (for All Sizes) or $15 Specialty Shirt (All Sizes), Per Person (8/15 - 11/16/24) * Select one Small Medium Large Extra Large XXL XXXL

Please Calculate the Grand Total for Registration & T-shirt Fees (manually, below) *

Please place Form of Payment below (ex: Zelle, Payment via Check or Money Order by Mail or Electronic Payment* ( *proceed to page using the Menu options), Submit Grand Total: *

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