MENTAL HEALTH DAY AT THE CAPITOL
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BECOME A SPONSOR
The Behavioral Health Services Coalition is "gearing up" for the 2010 Mental Health Day at the Capitol on Thursday, March 4, 2010. As in years past, we are asking for financial contributions so that we can pay for legislators' meals and keep the registration fee affordable.
Levels of donation: 5 STAR $5,000.00
4 STAR $3,000.00
3 STAR $1,000.00
2 STAR $ 500.00
1 STAR $ 200.00
Organizations contributing a minimum of $50 and individuals contributing $25 will be listed as "donors" in the program. As always, donations in any amount are greatly appreciated.
Please fill out and return the form below by January 30, 2010. Checks should be made payable to the Coalition's fiscal agent,
Georgia Parent Support Network
1381 Metropolitan Parkway
Atlanta, GA 30310
Fax: 404-758-6833
Questions can be directed to Rheba Smith at GPSN at 404-758-4500.
Thank you for all you do on behalf of the mental health movement!
___ Yes, I would like to be a Sponsor for the 2010 Mental Health Day at the Capitol
(__ As part of my sponsorship, I would like to display a table at the event)
Sponsorship Level:
___ Yes, I would like to be a Donor for the 2010 Mental Health Day at the Capitol
(__ $50 for organizations $25 for individuals)
___ I would like to make a donation to support this important mental health event.
Organization:__________________________________________________
Contact Name: ______________________ Email: ______________________
Address: _____________________________________________________
____________________________________________________________
City: _____________________________ State: ________ Zip Code:________
Phone: ___________________________ Fax:________________________
For credit card payments: Total Amount to be charged: $_______________
Name (as it appears on the card): ________________________________
Acct. #: __________________________ Exp. Date: _______________
Signature: ________________________ 3-digit V-Code on back: ______
