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MCOA Fall Conference Registration
Please enter your name and organization as you would like it to appear on your name tag.
First Name
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Last Name
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Title
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Organization
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Billing Address
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City
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State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
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Phone Number
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Fax #
Email Address
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Are you or your Senior Center a member of MCOA, or EOHHS, NCOA, NISC, RISCDA, CASCP, NHASC, or one of our community partners: MMAHSC, AARP, Alzheimer’s Association, Jewish Family & Children's Services, MGA, MASS ALA, MAOA, MSAC, MA Council for Home Care Aide Services, MA Health Policy Forum, MA Healthy Aging Collaboration, MA Multicultural Coalition on Aging, Mass Senior Care Association, MPHA, MA-NASW, Tufts Health Plan Foundation, LeadingAge MA, or the UMass Gerontology Institute: Then you are entitled to pay Member Rates.
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Yes
No
If yes, which organization are you with?
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MCOA
EHHOS
NCOA
NISC
RISCDA
CASCP
NHASC
MMAHSC
AARP
Alzheimer's Association
JF&CS
LeadingAge MA
MGA
MASS ALA
MAOA
MSAC
MA Counsel for Home Care Aide Services
MA Healthy Aging Collaborative
MA Health Policy Forum
Mass Home Care
MA Multicultural Coalition on Aging
Mass Senior Care Association
MPHA
MA-NASW
Tufts Health Plan Foundation
UMass Gerontology Institute
Other
If Other, please specify
Box 2: Member Pricing *
Please note that cost does not include hotel room. Please see the
Sea Crest link
for room pricing.
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Complete Conference 3-Day Package with Evening Events. Includes all Breakfasts, Buffet Luncheons and Breaks and includes Wednesday Dinner and Thursday Networking Event ($515)
Three-Day Workshop Package - Daytime Only. Includes all Breakfasts, Buffet Luncheons and Breaks but does not include Wednesday Dinner or Thursday Networking Reception ($455)
Wednesday Only. Includes four sessions, a breakfast, a buffet luncheon and 2 breaks ($190)
Thursday Only. Includes four sessions, a breakfast, a buffet luncheon and 2 breaks ($190)
Friday Only. Includes a morning intensive, an afternoon wrap-up session, a breakfast, and a buffet luncheon ($140)
Wednesday's Dinner ($80)
Thursday's Networking Event ($40)
If you are not a member of one of the organizations above, you need to pay non-member rates.
Please note that cost does not include hotel room. Please see the
Sea Crest link
for room pricing.
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Complete Conference 3-Day Package with Evening Events. Includes all Breakfasts, Buffet Luncheons and Breaks and includes Wednesday Dinner and Thursday Networking Event ($805)
Three-Day Workshop Package - Daytime Only. Includes all Breakfasts, Buffet Luncheons and Breaks but does not include Wednesday Dinner or Thursday Networking Reception ($695)
Wednesday Only. Includes four sessions, a breakfast, a buffet luncheon and 2 breaks ($260)
Thursday Only. Includes four sessions, a breakfast, a buffet luncheon and 2 breaks ($260)
Friday Only. Includes a morning intensive, an afternoon wrap-up session, a breakfast, and a buffet luncheon ($220)
Wednesday's Dinner ($105)
Thursday's Networking Event ($70)
I am willing to be a room monitor for a workshop.
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Yes
No
To assist MCOA in planning room size requirements and to ensure that speakers have sufficient handouts, please indicate the workshops you may attend on Wednesday, Thursday and Friday. This is a preliminary designation - you can change your mind later. Also, the workshops are subject to change due to unexpected circumstances.
Please enter the number code found listed to the right of the workshop title in the
Conference Booklet
:
Wednesday, October 19
Session 1
Session 2
Session 3
Session 4
Please select the workshops you would like to attend
W1-1
W1-2
W1-3
W1-4
W1-5
W1-6
W1-7
W1-8
W1-9
W2-1
W2-2
W2-3
W2-4
W2-5
W2-6
W2-7
W2-8
w2-9
W3-1
W3-2
W3-3
W3-4
W3-5
W3-6
W3-7
W3-8
W3-9
W4-1
W4-2
W4-3
W4-4
W4-5
W4-6
W4-7
W4-8
W4-9
Thursday, October 20
Session 1
Session 2
Session 3
Session 4
Please select the workshops you would like to attend
T1-1
T1-2
T1-3
T1-4
T1-5
T1-6
T1-7
T1-8
T1-9
T2-1
T2-2
T2-3
T2-4
T2-5
T2-6
T2-7
T2-8
T2-9
T3-1
T3-2
T3-3
T3-4
T3-5
T3-6
T3-7
T3-8
T3-9
T4-1
T4-2
T4-3
T4-4
T4-5
T4-6
T4-7
T4-8
T4-9
Friday, October 21
Session 1
Session 2
Please select the workshops you would like to attend
F1-1
F1-2
F1-3
F1-4
F1-5
F2-1
F2-2
F2-3
F2-4
F2-5
CEU Application
If you are interested in applying for CEUs, please indicate which ones you would like and add this subtotal to your final amount. Note: Not all workshops will offer CEUs, but MCOA tries to offer at least one per session. The full list of workshops offered will be available online one week prior to the event and on-site at the Resolution Desk. You may also sign up and pay on-site for this.
Nursing CEUs ($20)
Licensed Social Workers CEUs ($20)
Licensed Mental Health Counselor CEUs ($20)
CECs for MCOA Certified Program Managers ($10)
CECs for MCOA Certified Directors ($10)
Box 5: Additional Meals for Spouses or Guests (Registrant meals are included in registration) Please enter the quantity of tickets needed in the box provided. Note: These tickets do not allow entrance into workshops.
Breakfast Spouse/Guest Member Weds ($15)
Breakfast Spouse/Guest Member Thurs ($25)
Breakfast Spouse/Guest Member Fri ($25)
Lunch Spouse/Guest Member Weds ($35)
Lunch Spouse/Guest Member Thurs ($35)
Lunch Spouse/Guest Member Fri ($35)
Evening Events Spouse/Guest Member Weds ($80)
Evening Events Spouse/Guest Member Thurs ($40)
Box 5: Additional Meals for Spouses or Guests (Registrant meals are included in registration) Please enter the quantity of tickets needed in the box provided. Note: These tickets do not allow entrance into workshops.
Breakfast Spouse/Guest Non-Member Weds ($20)
Breakfast Spouse/Guest Member Thurs ($35)
Breakfast Spouse/Guest Member Fri ($35)
Lunch Spouse/Guest Member Weds ($50)
Lunch Spouse/Guest Member Thurs ($50)
Lunch Spouse/Guest Member Fri ($50)
Evening Events Spouse/Guest Member Weds ($85)
Evening Events Spouse/Guest Member Thurs ($50)
Box 6: If you have any special needs, contact MCOA as soon as possible or list here: (Include any dietary restrictions and any and all accessibility issues.) Menu selections for this event are posted online. List your needs here or address individual concerns to MCOA Director of Members Services, Kathy Bowler, at
kathy@mcoaonline.com
. Put "MCOA Conference Needs" in subject Line of email. Unless we are notified by October 5th we cannot guarantee that we can meet your needs. We will do the best we can.
Vegetarian
Vegan
Gluten Free
Other
Other
Box 7: Hotel Reservations: Deadline is September 18 for Guaranteed Discount
Go online to
www.mcoaonline.com
for the room reservation link to reserve a room under the "Mass Councils on Aging." MCOA receives price reductions for the total number of hotel nights "sold." In order to double-check this process, we ask you to submit the following information. Please indicate the nights you have reserved:
Oct 17
Oct 18
Oct 19
Oct 20
Oct 21
Oct 22
Other Dates
None at this hotel
Other
Other
Cancellation and Payment Policy
MCOA is pleased to offer workshops, events and trainings, and does have costs associated with these events.
Attendees who have registered for any MCOA function, may cancel up to the closing date deadline (
October 5, 2022
). If you are unable to attend our function, we request notification prior to the closing date deadline (
October 5, 2022
).
Registrants may send an alternate person to the event.
After that time, MCOA is obligated to the caterer and speaker for the costs incurred and will pass along that cost to the registrant.
A registrant who has cancelled before the closing but paid for the function will be able to apply the fee towards the next function.
Cash will no longer be accepted onsite. If not previously paid, invoices will be sent after Ocotber 5.
Attendees (and their organizations) with a history of unpaid invoices will not be allowed to attend any event without prior payment.
To cancel, please submit your cancellation in writing to shari@mcoaonline.com by 10/5/2022.
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I have read and agree to the above policy
Photography disclosure:
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MCOA takes photographs during its conference for use in event advertising, newsletters and other promotional materials, whether in print, electronic or other media, including the MCOA website (www.mcoaonline.com). By participating in this event, I grant MCOA the right to use my name and photograph for such purposes.
Please add me to the MCOA email list for news and other notices