End of Life Care Community Training — Organization/Group Discount Application
INSTRUCTIONS:

Thank you for your interest in our course. We strive to make this course accessible to all organizations and groups, and are pleased to offer discounts to support continuing education.

Please complete this form in its entirety. We will contact you via email.

If you have any questions or concerns regarding this form or the application process, please email education@eolcny.org. Thank you for taking the time to complete this form.
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Organization Name *
Your name *
Your title/role *
Your email address *
Your organization's website *
If you do not have a website, please briefly describe the organization
Type of organization *
How did you hear about this program? *
How many people will take the course? *
What is the occupation of the individuals who will take this course? (check all that apply) *
Required
Which communities/populations does your organization serve in New York? (check all that apply) *
Required
Is there any other information that would be helpful for us to know?
Here you can share additional information about your team, areas of interest, financial constraints, or other matters.
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