Georgia Legislative Black Caucus, Inc.

2010 ALW

Individual

Registration Form

Complete Registration Fee
$300 Fee includes admission to: Dinner Cruise Women's Breakfast Legislative Luncheon Healthcare Luncheon Black Tie Gala Workshop Low Country Boil Cookout Reception

Name:	*

Organization:
Mailing Address:
City:
State:
Zip:
Phone:	*
Alt. Phone:
Email:	*
Website:


* = required fields

Make check payable to The Georgia Legislative Black Caucus, Inc., In memo section please list: 2010 ALW Registration Mail check and form to GLBC, Inc. P.O. Box 38028, Atlanta, GA 30334 GLBC Tax exempt number: 58-1500919 Contact GLBC GLBC Phone: (404) 651-5569 Fax: (404) 651-6984

" Words " From The Chairman

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