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Sign up for the September 15, 2011 Lansing meeting:

Last Name:
First Name:
Title:
Organization:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:

Nurse CE:(SS#)
SW CE: (SW ID#)
Check will be mailed:	REMINDER: Payment due September 7. Make check for $100.00 payable to Lansing Community College.

Meal(s):

I require a vegetarian meal.

Additional Info:
NOTE: IF YOU DON'T RECEIVE A CONFIRMING EMAIL WITHIN 5 DAYS, EMAIL  MATT BEHA AT BEHAM@LCC.EDU OR CALL 517/483-1529.

 

Mental Health & Aging Project
Phone: (517) 483-1529
Additional contact information »