Registration Form

For

Understanding Alzheimer’s
And When Hospice Can Help

Presenter Carol Waarala, LMSW

Hospice Medical Social Worker
Certified Specialist in Aging
Odyssey HealthCare, Southfield, Mi

When Thursday, May 13, 2010, 6:30 to about 8:30 PM

Where United Methodist Church of Swartz Creek

7400 Miller Rd
Swartz Creek, Mi 48473
810-635-4555
In the Sanctuary (enter door 2)

Cost Free to you and the community-

however we do need your pre-registration information
to provide for hand-out materials and volunteer staffing needs.
There is ample, yet limited open seating.

Care A nursery will be provided with your pre-registration.

A care room will also be available and staffed with qualified volunteers
for those with Alzheimer’s disease so their care giver may attend the
program.

Information Required:
Contact Name ___________________________________________
Telephone number ________________________________________
Number attending the presentation ___________________________
Number of and age of those needing nursery care ________________
Will you be bringing an Alzheimer’s patient using the care room? ___

Please fill out this form and return it to:

United Methodist Church of Swartz Creek
7400 Miller Rd
PO Box 268
Swartz Creek, Mi 48473

Refreshments will follow the presentation.

(Please feel free to duplicate this form and share it with others.)