Register for the November 2017 Medicare/Medicaid Seminar
Register below for the 2017 "Can Someone Please Tell Me the Difference Between Medicare and Medicaid?" seminars presented by AGE of Central Texas. The seminar will be presented by healthcare lawyer Trelisha Brown from the Texas Legal Services Center, discussing the specifics of both Medicare and Medicaid coverage, and what will be changing in the new year.
This year's seminar will be offered twice – once in Austin and once in Round Rock -- and you can select the date below that is most convenience for you:
- Saturday, November 4th, from 10:00 am to Noon in Round Rock at the Restoration Church (475 Round Rock West Drive, Suite 110; Round Rock, TX 78681)
- Saturday, November 11th, from 10:00 am to Noon in Austin at the AGE Building (3710 Cedar Street, Austin, TX 78705)
Each seminar is free, but advance registration is required, so we can be prepared with enough materials for all attendees.
Free senior adult respite will also be available for both seminars. You must indicate if you want to RSVP for the free elder care respite in this form (walk-ins cannot be accepted that day).
If you need help completing your registration, please call Victoria Ellenburg at 512-600-9275.
My First Name
My Last Name
My Email Address
Select the date you wish to attend:
Saturday, November 4th, from 10:00 am to Noon in Round Rock at the Restoration Church (475 Round Rock West Drive, Suite 110; Round Rock, TX 78681)
Saturday, November 11th, from 10:00 am to Noon in Austin at the AGE Building (3710 Cedar Street, Austin, TX 78705)
Will anyone be joining you?
We do not require you to individually register each additional person who is planning to attend with you, as we will use this number for the purposes of our headcount. However, if your friend or family member has a loved one they would like respite care for during the seminar, they must register separately to RSVP for respite.
Have you ever attended one of AGE's caregiver seminars or conferences before?
No, this is the first seminar I've attended, but I've heard of AGE and/or used other services at AGE before.
No, and I had never heard of AGE before finding out about this seminar.
How did you hear about this seminar?
Select from the list below
From AGE's 'Caregiver Communique' or other email
On the AGE website
AGE's ENGAGE Newsletter
AGE's Facebook page
AGE's Twitter page
From a friend
From another organization
Would you like to sign up for AGE's monthly "Caregiver Communique" email newsletter?
What county do you live in?
Select from one of the following
What is your ZIP code?
Type your five-digit ZIP code
Will you need any special accommodations to attend the seminar?
Check all that apply, and we will do our best to accommodate your needs.
American Sign Language (ASL) interpreter
An assistant will be accompanying me
A service animal will be accompanying me
Would you like to RSVP for the senior adult respite for your loved one during the seminar?
If you plan to use respite, you must indicate this on or before November 1, 2017. Walk-ins are not accepted on the day of the seminar. Respite is provided on-site at AGE's Adult Day Health Centers.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service