|
The Bishop Gravatt Center, Inc. Name ______________________________________________________________________________ Mailing Address ______________________________ City/State/Zip _____________________________ Telephone __________________________________ Email ___________________________________ Coming with a group? Y N Group Name _________________________________________________ Special Needs (Dietary, Mobility, etc) ______________________________________________________ Cost for the program is $25* and includes lunch. Fifth registration from the same group (church, retirement community, etc) is free when forms are mailed together. As a nonprofit organization, Gravatt gratefully accepts your optional tax-deductible donation. Registration Amount Enclosed ________ Checks should be made payable to the Bishop Gravatt Center, or complete the credit card information below. ___Visa ___Mastercard ___Discover Mail or fax your registration: Please register by Monday, June 2, 2008. In case of cancellation, registration fee is refundable if request is received by June 2 - minus a $5 administration fee. |