REGISTRATION FORM
Leadership Conference
February 25, 2006

Co-sponsored by Glynn Environmental Coalition and Coastal Georgia Community College

To register, print this form, fill it out, and mail with $15 payment per person to: Glynn Environmental Coalition, P.O. Box 2443, Brunswick, GA 31521-2443

Name(s): ______________________________________________

Address:______________________________________________

            ______________________________________________

 
City:  ___________________________________

State: _________     Zip: _______________

Phone(s): ______________________________________________

e-mail: ________________________________________________
 

 Please make checks payable to the Glynn Environmental Coalition.

NOTE: CONFERENCE REGISTRATION CLOSES FEBRUARY 24th.