There are several ways you can register:

* Call Keith at: 404.589.9040 (PREFERRED METHOD)

* Email the required information to: Keith.Gibbs@PositiveImpact-ATL.org

* Fax the required information to: 404.589.1615, Attention Keith

Note that you MUST pre-register PRIOR to attending the event; individuals will not be permitted to drop in without a prior registration. It is recommended that you register as early as possible prior to the date you prefer to ensure you will get the date you desire.

The following information is required to register for the workshop. You will receive a confirmation telephone call acknowledging your registration and assuring you a place in the workshop. If you are registering for more than one person (such as registering as a couple), you must complete a SEPARATE registration for EACH person.

FIRST NAME:

LAST NAME:

DAYTIME TELEPHONE NUMBER:

DATE OF BIRTH:

RACE/ETHNICITY:

EMAIL ADDRESS:

SESSION YOU WISH TO ATTEND (day/date/time):

ALTERNATE DATE IN CASE PREFERRED SESSION IS FULL:

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