2. Presenting organization award registration

   Please sign up as a presenting organization using this form by February 7 at 5 pm. Payment will be due at the end of March. The awards are scheduled for 6:00 PM, April 23 in the conservatory of the State Botanical Garden of Georgia. The event will be followed by a reception. The estimated cost to participate will be $30 per awardee to cover the cost of the event.

4. Name of Business/Organization*
6. Contact First Name*
7. Last Name*
9. Phone Number (Mobile)*
10. E-mail*
12. Phone Number (Work)
13. Number of Awards Being Presented*
    -- Select One --12345
17. Title of Award Being Presented (#1)*
21. Title of Award Being Presented (#2)
25. Title of Award Being Presented (#3)
29. Title of Award Being Presented (#4)
33. Title of Award Being Presented (#5)
37. How will you be paying the $30 per award presenter contribution?*

    1. Check (preferred)
    2. Cash
    3. PayPal
    4. I need an invoice

38. Note: Checks can be made out to Keep Athens-Clarke County Beautiful, with “Green Life Awards Ceremony” noted in the memo line.

39. I understand that partners are contributing $30 per award to offset the event expenses.*

    1. Yes
43. Questions/Comments:
45. Please contact Stacy Smith, Program Education Specialist for Keep Athens-Clarke County Beautiful, at 706-338-9426 or stacy.smith@accgov.com for more information or if you have questions about the event.
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit Submit and Print

* indicates a required field