Put Yourself on Our Mailing List!

In the near future, we hope to make it possible for you to add yourself to our data base on line. For the moment, though, we must resort to lower-tech alternatives.

1. You can print this page, fill out the information, and send it to us by US mail.
2. You can send us your information by e-mail. Here are the steps:
   • Use your cursor to highlight the form. (The letters may turn white when you do this. Don't worry, they'll be all right when you paste them.)
   • Copy it. (Edit + copy or Control + c in Windows.)
   • Click on this e-mail address: mmorse@email.unc.edu
   • Paste the form into the message block. (Edit + paste or Control + v in Windows.)
   • Add your information.
   • Send it to us.

So here's the form:

[ ] Individual or [ ] Agency

Name or Agency Contact:

Position (for Agency Contacts):

Address:

City, State, and Zip:

Telephone Number (Optional):

E-mail Address (Optional):

Agencies may request multiple copies, but we reserve the right to limit the number we send.
How many copies? ____

Individuals Only
Profession/Discipline
(Check all that apply.)
[ ] Social Worker/Case Worker
[ ] Supervisor/Manager/Agency Director
[ ] Psychiatrist/Psychologist/Counselor
[ ] Pastoral Counselor
[ ] MD/RN/PT/OT
[ ] MIS Specialist
[ ] Other (please specify):

Agencies Only
Type of Organization
[ ] Department of Social Services
[ ] Agricultural Extension
[ ] Area Mental Health Center
[ ] Council/Department on Aging/AAA
[ ] Home Health Service
[ ] Hospice
[ ] Hospital/Clinic
[ ] Nursing Home/Adult Care Home
[ ] Religious Organization
[ ] Senior Center
[ ] Other (please specify):

To help us plan for future issues of ASPN, please let us know what topics would interest you most and help you in your practice with adult clients and their families.

Will this issue of ASPN be useful to you in your work? [ ] Yes [ ] No
What did you like most about it?

What did you like least?

Where do you look at the World Wide Web? [ ] Home [ ] Office [ ]Both

Have you or members of your organization attended training events offered by CARES? [ ] Yes [ ] No
What topics for training events on aging would be most useful to you or to your organization?

This is the end of the form.