Agency on Aging

Interagency Council Registration

 

Dues are $50 per organization - waived for non-profits and municipalities.  Your registration includes participation at all M-Team and Interagency meetings for as many staff from your organization who would like to attend. By registering your organization, lunch for one staff at the annual meeting in June will be free.  

(* Denotes Required Fields)

Please provide the following information.
Organization: *
Please check one: *
Organization is a:
Organization Contacts
Primary contact for Interagency. 
Name: *
Title: *
Email: *
Phone Number: *
Type of phone:
M-Team Contact, if different than above. 
Name:
Title:
Email:
Phone number:
Type of Phone:
Additional Contacts
Name:
Email:
Name:
Email:
Registration
If you are paying by check, please include an invoice with your check. A link to the form will be included in the email acknowledgement sent after your registration is completed. 
If you are making a payment by credit card, please enter the amount below. 
I will pay by credit card.: $ 
Credit Card Payment Information
Amount: $0.00
Card Type:
Card Number:
Name on Card:
Verification #: ?
Expiration Date:
Billing Address:
City, State, Zip:

Refunds are not processed through this website. All refund requests need to be submitted in writing to AOASCC's Finance Department.