End of Life Care Community Advocate Training — Group Discount Application

Thank you for your interest in our training. We strive to make this training accessible to all organizations and are pleased to offer group discounts.

Please complete this form in its entirety. We will contact you via email. Please note, completion of this form is not a guarantee of a discount or enrollment in the training.

If you have any questions or concerns regarding this form or the application process, please email education@eolcny.org. Thank you for taking the time to complete this form.
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Organization Name *
Your name *
Your title/role *
Your email address *
Your organization's website *
If you do not have a website, please briefly describe the organization
Type of organization *
How did you hear about this training? *
How many people would you like to have enrolled? *
What is the occupation of the individuals who will take this course? (check all that apply) *
Which communities/populations does your organization serve in New York? (check all that apply) *
Is there any other information that would be helpful for us to know?
Here you can share additional information about your team, areas of interest, financial constraints, or other matters.
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