MEMBERSHIP APPLICATION (Individual)

Children's Palliative Care Coalition of Michigan

Individual Membership Enrollment

Membership Categories:
"Professional" is a medical, social work or other professional directly involved in pediatric palliative care.
"Associate" is anyone intersted in partiicpating or supporting, not directly involved in pediatric palliative care.
"Member Employee" is an employee or a member of a corporate member of the Coalition. 
"Patient Family" 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 event discounts or other benefits.
Select dues according to Membership Category *
Click "Continue" to procceed to payment