Group Registration Form
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Name:
Title:
*
Address:
*
City:
*
State:
*
Zip:
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)
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Ext.
*
Phone:
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)
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Fax:
*
E-Mail:
Web Site:
* Required Field
Group Registration
Day 1
Day 2
Both Days
Group Rate
$59.00
$99.00
$150.00
Your Organization
Option A
Select your organization from the "Drop Down" menu below. After you have selected your organization continue to "Additional Information" below.
Select Your Organization Here
Office of Services to the Aging
Presbyterian Villages of Michigan
Michigan Community Reinvestment Coalition
Charlevoix County Commission on Aging
OCCOA
(If your organization is not in the "Drop Down" menu above use
Option B
)
Option B
If your organization was not listed in the "Drop Down" menu above enter in your organization's name below. After you have entered you organization's name continue to "Additional Information" below.
Organization:
Additional Information
I would like a Certificate of Attendance:
I have a disability which may require special considerations:
Note:
The Lunch and Learn sessions do
not
apply to the
Pre-Event
.
Please select your 1st Choice of
Lunch & Learn Sessions:
Track A.
Track A:
Please Select a Session to Attend
Session 1: Elder Law: What Juniors & Seniors Need to Know
Session 2: Myths of Grief and Loss
Session 3: Long Term Care as Part of Your Retirement Plan
Session 4: End of Life Planning
Session 5: Aging In Place and Universal Design
Session 6: Adult Learning and the Creative Arts
Session 7: Preparing Communities for Boomers
Session 8: Advance Directives
Session 9: Fears, Falls and Prevention
Session 10: Tuesday Toolmen Model Home Repair Program
Please select your 1st Choice of
Lunch & Learn Sessions:
Track B.
Track B:
Please Select a Session to Attend
Session 1: Identity Theft: Prevention & Detection in the Marketplace
Session 2: Media and the Mature Marketplace
Session 3: Career Busters: Caregiving Choices & Challenges
Session 4: Boomers, Internet, and the Knowledge Market
Session 5: The Power of Value-Based Marketing
Session 6: The Enrichment Factor: There's No Place Like Home!
Session 7: Boomerangs: ReInventing & Returning to the Workforce
Session 8: Economic Redevelopment: New Housing Options
Session 9: Twenty Insights into the Mature Marketplace
Session 10: American Legacies Study
Comments:
Method of Payment
Check:
Charge Card:
Conference Cancellation Policy
In order to receive a partial refund of your registration fee, your cancellation request must be received in writing prior to April 15, 2006. A $50 administrative fee will be charged for all cancellations, regardless of the reason for the cancellation (including medical emergencies). No refund of any kind, for any reason, will be given for cancellations requests received after April 15, 2006. Senior Summit cannot make exceptions to this policy. Refunds will be issued within 15 business days after the Conference on Aging in Northern Michigan concludes.
I agree to the terms listed above.
