Register for the FREE Williamson County Caregiver Conference on Sept. 23, 2017

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please register below for the 4th Annual "Williamson County Caregiver Conference" on Saturday, September 23, 2017, taking place from 9:30 a.m. to 2:00 p.m. at the Wingate by Wyndham Round Rock Hotel & Conference Center, 1209 IH-35 Frontage Road, Round Rock, TX 78664. The Conference is hosted by AGE of Central Texas and sponsored by AARP Texas.

The free Conference includes a keynote presentation by Mark Carlson, MD -- a board-certified geriatrician, internist, and oncologist with 25 years of healthcare experience who is the founder of Be Well MD -- speaking on "Getting the Most Out of Your Communication with Your Doctor." The Conference will also feature break-out sessions and community resources to support family members who are caring for a senior adult. Continental breakfast and lunch will also be provided, free of charge. Complete event information is online at http://www.AGEofCentralTX.org/WCCC.php.

The seminar is free, but advance registration is required, so we can be prepared with enough materials for all attendees.

You must indicate if you want to RSVP for the free elder care respite in this form (walk-ins cannot be accepted that day).

If you need help completing your registration, please call 512-600-9275.

My First Name *

My Last Name *

My Email Address *

Phone Number (include area code) *

Are you bringing a friend with you? If so, how many?

We do not require you to individually register each friend, as we will use this number for the purposes of our headcount.

Have you ever attended one of AGE's caregiver seminars or conferences before?

Yes!

No, this is the first seminar I've attended, but I've heard of AGE and/or used other services at AGE before.

No, and I had never heard of AGE before finding out about this seminar.

Clear selection

How did you hear about this seminar?

From AGE's 'Caregiver Communique' or other email

On the AGE website

AGE's Facebook or Twitter page

AGE's ENGAGE Newsletter

From a friend

From another organization

Other:

Clear selection

Please add me to the "Caregiver Communique" email list!

Receive AGE's monthly email newsletter, the "Caregiver Communique," written specifically for caregivers, with advance information on more upcoming free workshops, seminars, and conferences.

Check here to be added to the "Caregiver Communique" email list

Would you like to RSVP for respite for your loved one during the Conference? *

If you plan to use respite, you must indicate this on or before September 20, 2017. Walk-ins are not accepted on the day of the Conference. Respite is provided at the Round Rock AGE Adult Day Health Center, located at 475 Round Rock West Drive, #120; Round Rock, TX 78681..

Yes

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms