
Registration Form
This is not a "secure" transaction. If you
are uncomfortable sending your credit card number by e-mail,
use the registration from the printed flyer or print out,
fill out, and mail the Web version
of the registration.
Name
Address
Agency
Position
Phone, day
Phone, evening
Fees
Full day, includes morning and afternoon sessions and lunch $40.00
Half day, with lunch $27.50
morning
sessions only
afternoon
sessions only
Half day, without lunch $20.00
morning
sessions only
afternoon
sessions only
Continuing
education unit (CEU) certificate $10.00
(Full day registrants only.)
Please indicate choices for the concurrent sessions. Check
one box in each group.
Concurrent Sessions I, 10:2011:30 a.m.
Assessing
Housing and Health Care Needs of Community-Dwelling Older People
Making
Communities "Livable" for Older People
Cohousing:
An Option for People of All Ages
none
Concurrent Sessions II, 1:503:00 p.m.
Elderdesign:
Ten Design Principles for Aging in Place
The
Challenge of Naturally Occurring Retirement Communities
Integrating
Diverse Populations into Senior Housing
none
Concurrent Sessions III, 3:204:30 p.m.
The
Mod Squad: Philadelphias Team Approach to Home Modifications
The
New York State Health Department Report on Assisted Living
Housing
and Neighborhood Satisfaction among Older Adults: The Pathways
to Life Quality Study
none
Credit card authorization form
Card: MasterCard Visa
Name as it appears on card
Credit card number
Expiration date
Registration deadline: May 13, 1999
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