Powerful Tools for Caregivers

Please only register if you plan to attend all or most of the six weeks. Space is limited we can only allow a maximum of 12 people per session.

If you prefer to mail your information, download the form here.

Questions? Contact Patricia Soos at
(203) 785-8533 x. 3159, psoos@aoascc.org.

(* Denotes Required Fields)

Session I will attend
Choose a session:	Session 1: January 6, 13, 20, 27 and February 3, 10 Session 2: February 24th and March 3, 10, 17, 24, 31
Please provide the following information.
Your Name: *
Address: *
City, State and Zip Code: *
Phone Number: *
Email: *
Date of Birth: *
Last four of social security: *
Additional Information - required
I live alone or with someone other than a spouse and MY monthly income is approximately:
My Monthly Income:
I live with my spouse and OUR monthly income is about:
Our monthly income:
Please tell us about the care recipient.
Name: *
Address: *
City, State and Zip: *
Phone Number:
Email:
Date of Birth: *
Last four of social security:
Relationship to Caregiver: *
Primary Medical Condition: *
Additional Information - required
Lives alone or with someone other than a spouse and MY monthly income is approximately:
My Monthly Income:
Lives with spouse and OUR monthly income is about:
Our Monthly Income: