National Healthcare Decisions Day 2020 - Vermont Participant Form
Thank you for your interest in joining our statewide effort to spread awareness of the importance of advance care planning on National Healthcare Decisions Day 2020 (April 16). Please share your organization's plans on this date (or the surrounding week of April 12-18) via the form below.

Questions? Please contact
Your Name: *
Your answer
Organization/Facility Name: *
Your answer
Event(s) Planned (please be as specific as possible): *
Your answer
Date of Event(s): *
Your answer
Time of Event(s): *
Your answer
Resources Needed (please check which materials you anticipate needing to order beforehand; we will be in touch directly regarding quantities and billing):
Do we have your permission to promote the event(s) listed above in an upcoming press release, on the Vermont Ethics Network website, etc.? *
Is there anything else you'd like us to know?
Your answer
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