Program Fee: $134 (includes lunch, materials, and breaks) for both days;
$49 for Tuesday only; $99 for Wednesday only.

Limited scholarship funds are available to assist with tuition; call for information.

Last Name: _____________________ First Name & M.I.: __________________

Mailing Address:_____________________ City: ____________ State/Zip: __________

Home Phone: _____________ Work Phone: __________ Special Needs: __________________

Please make check out to Hospice of Midcoast Maine and mail to CDDD, c/o Hospice, PO Box 741, Brunswick, ME 04011; (207) 729-2721-fax. Payment is due at time of registration.