AG Registration December 2013

Question Title

* 1. Thank you for registering for the last Advocates Group meeting of the year, December 3, 2013 from 9 am- 11am. The meeting will be held at the Marion County Public Health Department at 3838 N. Rural Street. We will have a business meeting the first part of the morning then a small holiday party the last part of the meeting. If you want to participate in a $5 gift exchange, please bring a wrapped gift with you.

Name, company and email address are the only required fields for registration. If this is your first time attending a meeting, please complete all the contact information fields.

Name: *

Company: *

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address: *

Phone Number: