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

Quick Links:     ¬ Maine Hospice Event -- Aug 23, Brunswick
¬ 14th Annual Maine Pain Initiative Symposium -- Sep. 16-17, Samoset
¬ The Pervasive Influence of Grief and Loss on Mental Health -- Oct. 17, Eastland Park, Portland
¬ Annual Maine Hospice Council Retreat -- Oct 24-26, Sugarloaf
¬ Hot Topics in Hospice / Annual Blaine House Tea -- Nov 12, Augusta

Spring Maine Pain Initiative Registration

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

 

 

Individual Registration   

Individual registration fee: $79.00

Name:

Group Registration

Group registration fee:  $395.00 for groups of six (1 free for 5 paid)

Group:   Group Members:

Student Registration

NMCC Nursing students will be registered via class list provided by NMCC faculty. Other current nursing students are invited to attend and will receive a full scholarship, pending availability of funds.  Scholarship recipients will be notified by Monday, March 31.

Name:

 

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:

 

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) 

Will pay with Visa/MC/Amex/Disc/Echeck using PayPal     Will call with Visa/MC Number     Check in mail  

Mail check payable to: Maine Hospice Council, and mail to: PO Box 2239, Augusta, ME 04338

 

Registration/Cancellation Policy

 

Cancellations received on or before April 9, 2008 will be charged a $10 cancellation fee. No refunds will be made for cancellations received on or after April 10, 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 link below after submitting registration.


Go to PayPal Payment 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.

Shipping: 693 Western Avenue, Manchester, Maine 04351
Mailing: PO Box 2239, Augusta, Maine, 04338-2239
Toll-free: (800) 438-5963  Local: (207) 626-0651  Fax: (207) 622-1274  
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