MEMBERSHIP APPLICATION (Individual)

Children's Palliative Care Coalition of Michigan

Individual Membership Application

Membership Category (See "NOTES" below *
DUES: See notes below) *
NOTES:
"Professional" is a medical professional and those like social workers, therapists, etc, directly involved in pediatric palliative care.
"Associate" is a person interested or only indirectly 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.


QUESTIONS? 517-763-4413

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