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NC Coalition On Aging Event Registration & Donations

2019 Annual Meeting & Lunch Registration ...

COMING TOGETHER TO ADVOCATE FOR OLDER ADULTS

  • Date: Friday, September 27, 2019   Time: 12 Noon (Registration 11:30am)
  • Location: NC State University Club - 4200 Hillsborough St., Raleigh, NC ...directions
  • Key Note Speaker: Governor Roy Cooper
  • ...Save The Date Flyer

Registration Deadline September 13, 2019

You may register for the NCCOA Annual Meeting by printing the registration form or by completing the on-line registration form below. Registration Fee payments can be submitted in one of two ways:

  1. US Mail to NCCOA - PO Box 12762 - Raleigh, NC 27605-2762
  2. Pay by Credit Card / PayPal Account - Instructions to pay on-line will be provided once you submit the FORM below.

**NOTE: For those who wish to Print and Mail the Registration form, but wish to pay by credit card on-line you can do so by Clicking Here.

Contact mmbethel72@gmail.com for more information. Click Here to view/print a Flyer for advertising.

 

CONTACT INFO

NC Coalition on Aging
P.O. Box 12762
Raleigh, NC 27605

General Inquiries
info@nccoalitiononaging.org

Coalition Executive Director - Mary Bethel
executivedirector@nccoalitiononaging.org

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GENERAL DONATIONS..

The NC Coalition on Aging welcomes donations to help further our work on behalf of older North Carolinians. All donations are put back into our advocacy, public policy, and community action efforts.

Donate to NCCOA safely using PayPal

Coalition On Aging - 2019 Annual Meeting Registration Form

COMING TOGETHER TO ADVOCATE FOR OLDER ADULTS

NAME:
(required)

   
COALITION MEMBER?
(required)
 
 
IF AN ORGANIZATION / AGENCY / GROUP MEMBER - ENTER HERE:
 
ADDRESS:
 
CITY:
 
STATE:
 
ZIP CODE:
 
PHONE:
(xxx-xxx-xxxx) 
  
 
 
EMAIL:
(required) 
 
 
 
CONFIRM EMAIL:
(required)
(confirmation to help eliminate spam) 
 
 
 

Additional Persons Registering (Cost per Member - $25 / Cost per Non-Member - $35)

ADDITIONAL NAME #1:
COALITION MEMBER?
 
ADDITIONAL NAME #2:
COALITION MEMBER?
 
ADDITIONAL NAME #3:
COALITION MEMBER?
 
ADDITIONAL NAME #4:
COALITION MEMBER?
 
PAYMENT OPTION:
(required)  
   
INQUIRY / QUESTIONS:
(Certain Keyboard Characters are not permitted in the text box in order to keep spammers away. If you receive an error about this restriction, review text entered & remove semi-colons, colons, slashes, dashes, dollar signs, quotes, percent sign, links, URLs, etc.)
 
 

** A hardship provision is available if unable to pay the full dues amount.
Contact the Coalition Executive Director at executivedirector@nccoalitiononaging.org to find out more about the Coalition, or to answer questions about the Registration Form.