Online Community Directory (beta)
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YOUTH LINK
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(print and fill this form out; then, mail or fax it to the address or number
below)
Printed Directory_________copies ($40.00
each)
Total $________
Make check or money order payable to VIA LINK.
Please charge my :
(check one)
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Credit Card #_________________________ Exp. Date _______________
Signature _________________________ Phone # ___________________
TOTAL TO CHARGE TO MY ACCOUNT: $______________
Name ____________________________ Agency ____________________
Mailing Address _______________________________________________
_______________________________________________
Mail or fax to:
VIA LINK COMMUNITY RESOURCE
DIRECTORY
Helis Building, 1040 Calhoun Street
New Orleans, LA 70118
Office: (504) 895-5550 | Fax: (504) 895-5560