Website of the Maine Hospice Council and Center for End-of-Life Care

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Fall Maine Pain Initiative Registration

To register, complete this form and click 'Submit.' Space is limited, early registration is recommended.*

 

Individual Registration   

Name:

Group Registration

1 free for 5 paid

Group Members:

 

Additional Information

 
Organization (if representing):
Title:
Address Line One:
Address Line Two:
City, State, ZipCode:   
Daytime Phone:   Daytime phone number for questions.
Email: Registration confirmations are sent via email.
Special Requests:

 

Event Selection

 

Full Conference (all events)  --  $199  (Council members* $179)

Tuesday only -- New England Pain Initiatives,  5:00 to 8:30, includes dinner --  $35    (Council members* $30)

Tuesday only -- Pain Management at the End-of-Life: A Physician's Self-Study Packet   3:00 to 6:30, includes dinner -- $59          (Council members* $53)

Tuesday only -- Physician Roundtable   5:00 to 8:30, includes dinner  --  $59   (Council members* $53)

Tuesday only -- Two Events  --  $75   (Council members* $69)

Wednesday only   -- $139  (Council members* $125)

* Council members include individuals and organizations who pay annual dues to the Maine Hospice Council. Organizational members may use a limited number of reduced registrations, depending on membership level. Please contact the Maine Hospice Council for more information on membership and member discounts.

 

Workshop Selection

 

Workshop selections may be changed at any time, including the day of the event.

 

Morning workshops (select only one)

   * required *

 

Afternoon workshops (select only one)

   * required *

 

Lunch Selection (Wed only)

    * required *

 

Payment Information

 

Payment is expected at time of registration. On-line registrations will not be processed until payment is received.

Payment Method (check only one) 

   * required *

 

Registration/Cancellation Policy

 

Cancellations received on or before Sep. 1, 2008 will be charged a $15 cancellation fee. No refunds will be made for cancellations received on or after Sep. 1, 2008. Substitutions are allowed.

Please check this box to acknowledge understanding of our online registration and cancellation policy. If this box is not checked, your registration will not be processed.

 

Last Steps

Click 'Submit Registration' to send information to the Maine Hospice Council.  A page with your registration information will be displayed.

If paying with PayPal, click the 'Pay with PayPal' link on the Program page.


 

 

This site supported in part by funds from the Administration on Aging.

The Maine Hospice Council is a MaineShare Member Organization. For more information on workplace giving, please click here.

This page created by Al Hipkins using donated and low cost software and hardware. Please see our Acknowledgements page for a list of contributors and links to their sites.

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