Join the American Psychiatric Foundation and APA Alliance Saturday, May 5, 2001, for a Benefit Evening

Tickets for the dessert reception are $100 per person ($75 is tax deductible) or two tickets at $175 ($125 is tax deductible).

Name_____________________________________________________________________________________________________________

Address__________________________________________________________________________________________________________

Phone______________________________________________________________ APA Member Number____________________________

No. of tickets at $100_______ No. of tickets at $175_______

Checks should be made payable to the American Psychiatric Foundation or charged to MasterCard or VISA

Account Number_____________________________________________________ Expiration Date______________________________

Signature________________________________________________________________________________________________________

Please check one: Proceeds from this event to benefit APF__________ APA Alliance__________

Mail completed form to Barbara Matos, American Psychiatric Foundation, 1400 K Street, N.W., Washington, D.C. 20005; or fax it to (202) 682-3799. Faxed forms must include a MasterCard or VISA account number, expiration date, and signature to be processed. For more information call (202) 682-6286. PDF