ONE FORM PER PERSON
4TH ANNUAL EMPOWERMENT DAY
Thursday, June 11, 2009
“leaders In our Lives”
Sponsored by Detroit-Wayne County Community Mental Health Agency
Located at:
Burton Manor
27777 Schoolcraft Road
(I-96, just west of Inkster Road)Livonia, Michigan
8:00am-3:00pm
REGISTRATION FORM
Name: ______________________________________________________________
Address: ____________________________________________________________
City: _______________________________________________________________
Contact Phone:_______________________________________________________
Organization/Clubhouse_____________________________________________
Full breakfast and light lunch will be served. Please circle one:
Diabetic Vegetarian Regular
Fax registration forms to: 313 833-4280 OR e-mail to: aaltman@co.wayne.mi.us
Questions? Contact Anna (313) 833-7440 or Jamar (313) 833-9860
FORMS MUST BE RECEIVED NO LATER THAN JUNE 1
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