MHC LogoMaine Hospice Council and Center for End of Life Care 

Providing Excellence in End of Life Care

Maine Hospice Event

Individual & Team Member Registration

To register, complete this form and click 'Submit.'  All individuals and teams registered before August 1, 2010 will have their names posted on the "Online Pledge Form." Also, all individuals and team member registered before August 1 will receive an event T-shirt. Participants will be notified by email when on-line pledges are received.

Registration:  All participants please complete a registration form. If you are on a team, select which team from the drop-down box. If you do not find your team name, please insert the team name after your name. Team Captains, please complete the Team Registration form which is also your individual participant registration. Required information is marked with an asterisk*.

Name:*
Address:*
Phone:
Email:
Registration Type:*
if part of a team, enter team name here 
Event Type:*
Emergency Contact:*
T-Shirt Size: (registration must be paid by August 1st to ensure shirt size)
Payment Method:* (registration is complete upon receipt of payment)
Pledge Goal:
Agreement:* I agree to wear a helmet
 I agree to sign a "Liability Waiver"