Registration for Healthcare Proxy and Living Will Workshop (Brought to you by IAGB and India Circle for Caring USA Inc. - ICC)
Please enter 1 form per family and indicate the number of attendees. Workshop is free and open for all. However IAGB members will be given preference. Link to membership is provided in this form.
Name (First and Last name) *
Your answer
Email address *
Your answer
Phone number (111-222-333) *
Your answer
Number of adult attendees per family *
Please indicate if you are you a member of IAGB or ICC. Workshop is open for all. IAGB members will be given preference in registration. *
If you are an IAGB Annual/Life member, enter the name of the Primary Member's name below. If you wish to become a member please sign up for membership and provide the name here. Link - http://iagb.org/membership
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Location preference *
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