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Bridging the Gaps of Life - Palliative Care Event

Please complete a separate registration form for each attendee.

Saturday, February 1, 2014
Noon - 4:00 p.m.

2nd Ebenezer Church
14601 Dequindre Road
Detroit, MI 48214

If you are coming to be enrolled in a health insurance plan, make sure to bring the following:

  • Two forms of identification
  • Proof of insurance (If you already have insurance)
  • Your W2 form or your last year (2012) tax return
  • Method of payment (either personal check or credit card)
(All fields marked with *are required)

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