Circle your 1st, 2nd, and 3rd choice selection for each of the three sessions. Session A 9:45am – 11am Session B 11:15am – 12:30pm 3rd Choice B1 B2 B3 B4 B5 B6 1st Choice C1 C2 C3 C4 C5 |
Registrations accepted with a check or PO# only. $15 before May 23 | $20 after May 23Mail or fax this form with a check payment or PO #________ to:
Fax – 207-878-3172 or Attn: HOPE Conference
Conference volunteers who sign up by |
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name________________________________________ organization_____________________________________________
address_________________________________________________
city, state ____________________________ zip___________
phone____________________email______________________________
I identify as a: ¨ Peer/Consumer ¨ Provider ¨ Consumer and Provider ___I will need an American Sign Language Interpreter. ___I will be accompanied by an attendant. ___ I live 130 or more miles one way from the Augusta Civic Center and qualify for lodging reimbursement. Peers and Consumers ONLY ___I live 150+ round trip miles away and traveled in my own vehicle. Peers and Consumers ONLY I am able to volunteer during the week of May 21___or the day May 30 ____ Contact Melissa Caswell at mcaswell@maineccsm.org
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