Name: 

Organization Name: 

Home Phone:     Office Phone: 

Cell Phone:      E-Mail: 

Address: 

City:  State:  Zip: 

For more information, contact Alisha Linton at (850)921-0460 or e-mail her at Alisha Linton

Mail checks to: The Arc of Florida; 2898 Mahan Drive, Suite 1; Tallahassee, FL 32308
     (Payable to ARC FL and Memo: ARC Convention)

I will be paying via credit card through The Arc of Florida website at www.arcflorida.org
      (2.5% service charged will be assessed)