Celebrating 20 Years
Georgia Parent Support Network
6th Annual
"Unmasking Children's Mental Illness"
Mardi Gras Ball
$95.00
Tuesday, February 16, 2010
The Fabulous Fox Theater
6:00 pm - 9:30 pm
For more information call Rheba at (404) 758-4500.
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To register, please fax this form or send with your check to:
Georgia Parent Support Network, Inc.
1381 Metropolitan Parkway
Atlanta, GA 30310
FAX: 404-758-6833
NAME:
ORGANIZATION NAME:
ADDRESS:
CITY: STATE: ZIP:
EMAIL: TELEPHONE:
CHECK OR CREDIT CARD NUMBER: ________________________________EXP._____________
NAME ON CARD: __________________________________ 3-DIGIT V-CODE ON BACK: _______
TOTAL AMOUNT TO BE CHARGED: $_______ SIGNATURE: ____________________________
