There are several ways you can register:

* Call Jared Smiley at: 404.589.9040 (PREFERRED METHOD)

* Email the required information to: Jared.Smiley@PositiveImpact-ATL.org

* Fax the required information to: 404.589.1615, Attention Jared

Pre-registration is required; drop-ins are not permitted. 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 90-minute session. You will receive a confirmation telephone call acknowledging your registration and assuring you a reserved place. 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:

All information provided is confidential and is not shared with anyone, nor is it used for other purposes in the agency. A daytime phone number is required so we can contact you to confirm your reservation. A discreet message is left if we receive voicemail.