Online Registration Form

  • Use this form to register for the 2008 Maine LGBTI Health Summit. Complete the fields below and click on Submit Form at the bottom of the page. Fields marked with an asterisk are required.

  • Please Submit a separate form for each person.

  • You can mail your payment or Purchase Order to AdCare Educational Institute of Maine, Inc., 75 Stone Street, Augusta, ME 04330 or you can pay at the door. Payment or a Purchase Oder is required before admittance to the conference.

  • Due to space limitations, preregistration is required. Registrations are accepted on a "first come" basis.
  • The registration deadline is May 19, 2008 or May 9, 2008 if you are requesting special accommodations.
  • Register early to ensure available seating
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  • We are looking forward to seeing you at the conference.

  • If you have any difficulties with this online registration form, please contact

    • *Name:
    Agency:
    *Address:
    *City:
    *State:
    *Zip Code:
    *Telephone:
    Fax:
    *Email Address:
    *Continuing Education Certificate - Choose One
          General
          Nursing
          CME
          Social Worker

    *Payment Options (fee is $25) and includes Program, Continental Breakfast, Lunch, Breaks, and Continuing Education Credit:

         Will send a check.
         Will send a purchase order.
         Will pay at registration.

    Payment must be received prior to workshop attendance.

    Make check payable to: AdCare Maine and mail to:
    AdCare Educational Institute of Maine, Inc.
    75 Stone Street
    Augusta, ME 04330

    AdCare will send confirmation letters and directions to the workshop location after the registration deadline of May 19, 2008.


    Special Accommodations
    The conference site is wheelchair accessible.
    Sign Language Interpreters, Assistive Listening Devices or other accommodations are available on request.
    Please request accommodations prior to May 9, 2008.
    I request the following accommodation:
    Sign Language Interpreter
    Assistive Listening Device
    (Please specify type:)
    Other Accommodations
    (Please specify:)

    Sponsored By:
    Maine Department of Health and Human Services
    Center for Disease Control and Prevention
    Additional Partners, Sponsors, and Supporters

    Supported By:
    AdCare Educational Institute of Maine, Inc.
    For more information or to receive a brochure by mail or fax, please email:


    This web site is maintained by:
    AdCare Educational Institute of Maine, Inc.
    75 Stone Street, Augusta, ME 04330
    207-621-2549 (phone)
    207-623-0830 (TTY)
    207-621-2550 (Fax)