Bulloch County Drug and Alcohol Council
TIPS Registration Form

(Please print this page, then print or type the requested information and mail the Form.)

    

               Name ______________________________

               Establishment ______________________________

               Address ______________________________

               City ____________________ Zip _________

               Phone _________________________

               FAX __________________________

               Email ______________________________




               Please return this form to:
               Bulloch Alcohol & Drug Council
               PO Box 694
               Statesboro, GA 30459
               912-764-6405
               FAX 912-764-7221
               badc@frontiernet.net