Maine Humanities Council | Caring for the Caregiver, Registration

Conference Registration and Workshop Selection

There are two ways to register: (registration is closed, thank you.)

1. Paper: Download the registration form as a pdf, 264Kb. You can fill it out on your computer, print it and mail to us (address on form) with either a check or your credit card information.

2. Electronic: Registering electronically is easy! There are two steps involved—submitting the registration form to us and then sending your payment through PayPal. First, fill out the form on this page and submit it (instructions are at the bottom of the form). Then, use our link to Paypal to pay using either your credit card or a PayPal account.

Please note: This registration form is for the conference only. For hotel arrangements, please go to accommodations.

Registration Payment Date/Amount
$125 by no later than October 30th, includes Friday/Saturday continental breakfasts, Friday dinner, and Saturday lunch. Below, you also have the opportunity to pre-order a boxed lunch for Friday for an extra $13.00.

Refund Policy

We will send you a confirmation when we receive both your payment and completed registration form.

Thank you!

Contact Information (will be shared in public contact list) First Name:

Last Name:

Position:

Specialty:

Organization:

E-mail:

Phone:

Home Phone? or

Work Phone?

Mailing Address Street:

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Updates

We will contact you with further updates via email. If you would prefer phone or fax, please fill out the appropriate field below.

Phone:

Fax:

Emergency Contact Information Emergency Contact:

Home Phone:

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Continuing Education Credits Indicate what type of Continuing Education Credits you will need (if appliable):

Special Requirements I require vegetarian meals:

I require accommodations
in accordance with the
Americans with Disabilities Act:

Please specify needs:

Workshop Preferences

Workshops run concurrently within each session. Rank the box within each session in the order of your preference—from “1” (your first choice) through “5” (your last choice) in the spaces provided.

NOTE: We will make every attempt to see that everyone receives some of their top choices. We will send a confirmation of your workshop schedule by November 5th.

Exploring Grief and Loss: A Reflective Conversation with an Interdisciplinary Panel of Hospice and Palliative Care Providers [Betsy Hart, Greg Burns, Kandyce Powell] How to Show Results: Evaluative Design for Literature and Medicine Programs [Bruce Clary] Part 1 of 2 | How to Start a Literature & Medicine: Humanities at the Heart of Health Care® Program at Your Institution [Lizz Sinclair, Elizabeth Motts] Continues in Session II. Spiritual Grounding for Health Care Professionals [Marguerite Stapleton] What’s a Nice Discipline like Literature Doing in a Medical School? [Kathryn Montgomery]

This lunch is on your own, though if you think you will participate in one of the two activities listed below, we recommend pre-ordering an on-site boxed lunch.

Small Group Conversations: You will receive a group number so that you may participate in a randomly pre-assigned conversational group. [Also offered during Saturday breakfast.] No pre-registration necessary.

The Writers and Readers Circle: Victoria Longino from the Medical Humanities Interest Group of Massachusetts College of Pharmacy and Health Sciences will moderate this informal gathering where attendees can read aloud and talk about their own healthcare-related writing—short or long, incubating or completed. Victoria and her colleagues will also share their own work. [May be offered at additional times if desired.] No pre-registration necessary.

Boxed Lunch:

I would like to pre-order a turkey sandwich boxed lunch for $13:

I would like to pre-order a veggie wrap boxed lunch for $13:

No, thank you—I will get lunch on my own.

[Each boxed lunch includes sandwich or wrap, chips, fruit, cookie, and choice of beverage.]

Art & Meaning in the World of Health Care [Susan Bell] Balance & Boundaries: Personal Reflections on the Professional Life [David Loxterkamp, Hugh Silk]Also offered in Session III. “Fact” vs. “Truth” in Narratives of Illness [Rafael Campo] Part 2 of 2 | How to Start a Literature & Medicine: Humanities at the Heart of Health Care® Program at Your Institution [Lizz Sinclair, Elizabeth Motts] Continued from Session I. Narrative Medicine Writing Workshop [Rita Charon] Also offered in Session IV. Two Successful Approaches to Incorporating the Humanities in the Education of Health Care Professionals [Marjorie Boyd, Ann Lemire, Martin Kohn]

The Art of Facilitating: A Look at Group Dynamics [Betsy Burtis] Balance & Boundaries: Personal Reflections on the Professional Life [David Loxterkamp, Hugh Silk]Also offered in Session II. A Clinician’s Guide to the Soul [Veneta Masson]Also offered in Session IV. The Courage to Write: Finding Your Voice Through Creative Writing [Judy Schaefer] Getting Intimate: Using Humanities in Medicine to Approach the Human Body [Lois LaCivita Nixon]

The Caretakers’ Dilemma: Breaking the Silence [Kathleen Sullivan] A Clinician’s Guide to the Soul [Veneta Masson] Also offered in Session III. Looking at Diversity through the Lens of Film [Beth Ellers] Medical Readers’ Theater [Todd L. Savitt, Alyce Getler] Narrative Medicine Writing Workshop [Rita Charon] Also offered in Session II.

Comments/Questions Please let us know how you heard about this conference and any additional comments or questions:

Submit Form

Press the Red Button to submit this form to us, then print the “Thank You” page that you will then see for your records. If you want to submit payment via PayPal, come back to this page and use a PayPal button below. Registration is closed now, thank you.

PayPal : Payment

Pay for the conference ($125) and a boxed lunch for
Friday ($13) via PayPal. Please type your name and
"Caring for the Caregiver" in the "Add special
instructions to seller" box in the PayPal form.

Pay for the conference ($125) via PayPal. Please type
your name and "Caring for the Caregiver" in the
"Add special instructions to seller" box in the PayPal form.

If you have a problem with this form, please contact Annie Medeiros or call (207)773-5051.