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Third Annual
Massachusetts Rural Health Summit

Building Partnerships for Better Health

Thursday, November 21, 2002
Southbridge Hotel and Conference Center
Southbridge, MA
8:30 am - 4:00 pm

Registration Information

Name

_____________________________________________________________________

Organization

_____________________________________________________________________

Address

_____________________________________________________________________

Town/St/Zip

_____________________________________________________________________

Home Phone

_____________________________________________________________________

Work Phone

_____________________________________________________________________

FAX

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Email

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Please send me more information regarding New England Rural Health RoundTable

NO REGISTRATION FEE
LUNCH PROVIDED

Please circle concurrent session preference:

A or B

We welcome you to bring materials about your projects or programs to leave in the exhibit area.

  • Will you be bringing materials to place in the exhibit area?
    YES or NO
  • Will you need an entire exhibit table for your display?
    YES or NO
Accessibility and Special Accomodations. To request special accomodations, contact Joanne Hapeman, 413.586-7525

Please complete all applicable sections and return the registration
BY MAIL OR BY FAX
TO

Joanne Hapeman
MA Department of
Public Health
Western Regional Office
23 Service Center
Northampton,
MA 01060

Fax:
413.784-1037

For More Information call:

Pat Dempsey
508.792-78890

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