MEMBERSHIP APPLICATION (Individual)

Children's Palliative Care Coalition of Michigan

Individual Membership Application

Membership Category (See "NOTES" below *
DUES CATEGORY: See notes below) *
NOTES:
"Professional" is a medical, social work or otehr professional, etc, directly involved in pediatric palliative care.
"Associate" is a person inot directly involved in pediatric palliative care.
"Employee/member" is an employee or a member of a corporate member of the Coalition. 
"Parent" is a parent of a child in palliative care or who has been in palliative care. Benefits apply to both parents.
"Student" means full time student whether post graduate or undergarduate.
"Supporter" is any member who wants to be kept in touch, but without registation discounts or other benefits.
QUESTIONS? 517-763-4413
 
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