Here is the place to respond to our invitation to the August 26th meeting in Atlanta that will explore the feasibility of holding a Work Disability Prevention Summit in Georgia.  Further information is available at www.60summits.org.

Are you interested in participating in any way? yes   maybe   no

If yes or maybe, please help us plan by telling us your intentions on the issues below:

1. Attending Thursday August 26th feasibility session from 11 AM to 2 PM at the offices of Select Medical.  Address is 1140 Hammond Drive, Bldg D, Suite #4260, Atlanta, GA 30328.  Select Medical has also kindly agreed to provide lunch.

I will definitely be there

I may be there

I can only participate remotely - send me the call-in number if that option is available

I will not attend

Other - please elaborate

2. Involvement in an Georgia Summit planning effort:

I definitely want to be a part of this initiative

I may want to participate, but need to find out more

I don't want to plan a Summit, but would like to attend one

Other - please elaborate

3. Staying in touch:

Keep me on the 60 Summits mailing list

Take me off your mailing list

Personal information (will not be sold or shared)

Name
Degrees / Profession
Role / Title
Organization
Phone Number(s)
Preferred Email Address(es)

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