Name: _________________________________________________________
Address:________________________________________________________
Town/City:_______________________________________________________
State & Zip Code:_________________________________________________
Telephone:______________________________________________________
Please make sure you include a number in case we have questions to helpmeet your conference needs.
Dietary Needs: DIABETIC VEGETARIAN BLENDED
Is there an accessibility accommodation we can offer to make your conference experience more enjoyable?_______________________________________________________________
I will be attending:
________It’s My Life, in Presque Isle on Oct. 15 (Reg.1)
________Stronger Together, in Brewer Oct. 21 (Reg.2)
________Changing Lives, in Lewiston Sept. 29 (Reg. 3-6)
A registration form must be filled out for each conference attendee and accompanied by a $ 50.00 registration fee for each conference you plan to attend. No exceptions! Please feel free to photocopy this form if needed.
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