LifePlan Workshop Registration Form  
                                                         
To register for a workshop you may print this form, fill it out and mail it  with a check for $25 per
person attending.  (This fee will be deducted from total cost of the workshop.) For more information
please call: 208 409-6858.   Please send registration with your check made out to:

                     Elsa Freeman, 17322 Can-Ada Road, Nampa, Id 83687     


  Advance Directives Workshop      
                                                           
Cost:            Individual   $50                                                 

               Final Wishes Workshop                  
                                                                        
              Cost:         Individual    $75                            

                                                                                                 Total Cost   __________
         
Registration must be received prior to workshop. Once we have received your  registration
we will forward a packet to you with all of the information you will need to participate.
Each workshop lasts approx. 1 1/2 hour.
                                                      
Name:_______________________________________________________________________
                                      Last                                                             First                                                           Middle
 Address:_______________________________________________________________________________

                  ________________________________________________________________________________

 Phone:  ___________________ E-mail: _____________________________________________

Each Workshop Includes:  All of your documents and step by step instructions to complete them.
At the end of the workshop you will have all of your documents witnessed, notarized and copied. You
will also receive a folder containing other important documents, forms and information including:
POST (physicians orders for scope of treatment), DNR (do not resuscitate), organ donor form,
Important emergency information, and much more. 
All of your personal information and choices will be kept private. 

During the workshop you will be able to complete all of these listed documents:   

If you've been trying to figure out how to approach a parent about getting this done, why not invite them to join
you.  This is not just for 'old' people. If you are an adult you need to have these documents completed.  We never
know when an accident or illness may strike.

_______________________________________________________________________________________

 To be completed by LifePlan:  Total Cost: _________ Less Amt. received: ________Ck# _____

 Balance due at session:  ________     Received by ________  Check # ________  Cash  ________