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Spiritual Care Day at Michigan Medicine
Please use the form below to register for Spiritual Care Day on Friday June 9, 2023. Email (email umhs-chaplain@med.umich.edu) with any questions
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Name
Your answer
Email Address
Your answer
Hospital (or other facility affiliation)
Your answer
Pronouns
Your answer
Role
Staff Chaplain
CPE Student
CPE Educator
Manager/Director
Other Role
Dietary Needs
Vegetarian
Halal
Kosher
Vegan
Gluten Free
Other
No preference
Accommodations (visual, hearing, physical, religious other- please describe)
Your answer
Meal Payment Choice
Cash (brought day of event)
Check (brought day of event, made out to Spiritual Care, Michigan Medicine
Credit Card (email
umhs-chaplain@med.umich.edu
for instructions)
Need to discuss (email
umhs-chaplain@med.umich.edu
)
Other
Clear selection
Other Comments
Your answer
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