Name of Group:

Address:

Contact Person: Telephone:

Please indicate preferred date and time.

1^st Choice:      Date:   Time:

2^nd Choice:     Date:   Time:

Topic:     "Hospice: A Special Way of Caring"

     15 minute presentation

     30 minute presentation

     slide presentation         

Number of people anticipated:

If different from above information:

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Telephone:

We have speakers on a wide range of topics, including: "How to talk to your doctor", "All About Health Care Proxies", "Caring for the Caregiver" and many other end-of-life issues. Please call 718-226-6450 for further information.