Registration for PMG Summer Program 2019
*Registration Must Be Confirmed Before Your Dates Are Official*
Facility
*
Address
*
Date
-
Month
-
Day
Year
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Population you serve
Expected number of residents or clients (8 maximum*) (*Does not include companions, staff, or family)
*
Contact Person
*
Title
Phone
*
E-mail
*
CHOICE OF DAYS: Specify
3 choices
of month & day (Mon, Wed, Fri only) between July 9 & August 31). We will try to accommodate your first choice.
Choice of days:
*
TIME OF DAY YOUR GROUP PLANS TO ARRIVE
*
Morning
Afternoon
Questions? E-mail Kathleen Kennedy at
kjkcork@aol.com
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