Please fill out the form below.
Copy the form
Attache your registration fee to the form
Send it to:
Chaplain Bette Goglia, BCC
Mary Washington Hospice
5012 Southpoint Pkwy. 
Fredericksburg, Virginia  22408

(A copy of this form will automaticly be emailed to Bette)

Members registration $100
Non-Members $130
                 Become a 2009 member (Applications)
                      2010 membership begins on October 1st 2009