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Hill Visits Program

Get up and Go: A Falls Prevention Program





2008 CONGRESSIONAL HILL VISITS PROGRAM
Registration Form


Please check all that apply:
 I will be attending the Member Briefing Session
 I plan to schedule a Congressional Visit

Name:
Home Address:
City:
State:
Zip:
Phone:
Fax:
Email:
Names of U.S. House member and two Senators:

Questions? Contact Alanna Goldstein at 212-308-1414 or
agoldstein@americangeriatrics.org.