Georgia Legislative Black Caucus, Inc.

<% If Request.Form.Count > 0 Then For I = 1 to Request.Form.Count Body = Body & Request.Form.Key(I) & " " _ & Request.Form.Item(I) & vbCRLF Next '*** send email notice Set Mailer = Server.CreateObject("SMTPsvg.Mailer") Mailer.RemoteHost = "mail.galbc.org" Mailer.FromName = Request.QueryString("email") Mailer.FromAddress = "register@galbc.org" Mailer.AddRecipient "register@galbc.org", "register@galbc.org" Mailer.Subject = "2010 Soul Food Registration" Mailer.BodyText = Body Mailer.SendMail Set Mailer = Nothing Response.Redirect "2010_individual_registration2.html" End If %> Georgia Legislative Black Caucus, Inc.

2010 Soul Food

Registration Form

Online Registration Fee
$125 - Individuals $1,250 - Table for 10 Corporate Registrations, click here.



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




Make check payable to The Georgia Legislative Black Caucus, Inc., In memo section please list: 2010 Soul Food Registration Mail check and form to GLBC, Inc. GLBC Tax exempt number: 58-1500919 Contact GLBC GLBC Phone: (404) 651-5569 Fax: (404) 651-6984

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