[ APOC Home ]

APOC REUNION 2000
Registration Form

Please print and  fill out this registration form and make checks payable to:

U.S. Disabled Athletes Fund

You can RSVP by calling 770-850-8199.

Name  
Address  
City  
State  
Zip  
Phone (day)  
Phone (eve)  
eMail  
APOC affiliation:
_____ Staff
_____ Volunteer
_____ Family
_____ Friend		 Number of people attending:
Adults: _____ ($18.00 per person)
Children:____ ($14.00 per child 18 years and under)

Method of Payment:

Check (made payable to USDAF)

Credit Card:
VISA
 MASTERCARD
I authorize payment for the above items

Card#_______________________________________________________

Exp. Date: _________ Signature:__________________________________

Mail form and payment to:

USDAF
2015 South Park Place, Suite 180
Atlanta, GA 30339

Registration by credit card may be sent by fax to 770-850-8179.