REGISTRATION FORM TO ATTEND MINORITY
HEALTH WEEK VIP RECEPTION
click here to download Registration form
Friday, April 23, 2010 (6 – 9 p.m.)
Jones Plaza (Louisiana and Capitol)
Houston, TX 77002
I would like to attend the Minority Health Week VIP Reception. There will be ___guest/s in my group. Names (for badges) and addresses of attendees are listed below. Please fax this form to Annette Johnson @ 713-748-6320.
Name:_________________________________________________________________________
Organization:____________________________________________________________________
Street Address:__________________________________________________________________
City, State, Zip Code:_________________________________ Phone Number:_______________
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Name:_________________________________________________________________________
Organization:____________________________________________________________________
Street Address:__________________________________________________________________
City, State, Zip Code:_________________________________ Phone Number:_______________
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Name:_________________________________________________________________________
Organization:____________________________________________________________________
Street Address:__________________________________________________________________
City, State, Zip Code:_________________________________ Phone Number:_______________
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Name:_________________________________________________________________________
Organization:____________________________________________________________________
Street Address:__________________________________________________________________
City, State, Zip Code:__________________________________Phone Number:______________
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