Registration Form  

PLEASE NOTE: You may register by calling Susan at 645-3764 ext. 5280.

You may either fill your form out and submit online, or print out a form using the link below, following mailing instructions on the form.

 

Fill out and print the form below and mail to WMCA, or just hit the submit button for online sending.

Name:
Address:
City or Town:
State:
Zip Code:
Organization Name :
Email:
Telephone:

I Represent:

Community Members

Legislators/ Government

Advocates

Business

Faith Based/ Education

Providers


Workshop Request :

1st / 2nd Choice:

Income

Affordable Housing

Education

Health Care


Lunch Choices:

Turkey

Ham

Vegetarian

 

I require transportation/child care reimbursement

   

 

 Or mail:

WMCA
Attn: Susan Richards
Western Maine Community Action
PO Box 200, E.Wilton, ME 04234

Click here for Printable Form  

Space is limited - reserve your space early.

You will recieve a confirmation of your attendance with your lunch tickets via US Mail

E-Mail:
For General Information - srichards@wmca.org