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SCOSA Certificate in Elder Care Coordination Application Form

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* 1. Please provide us with your contact information.

Name

Position

Company or Organization

Street Address

City

State

Zip

Email Address

Phone

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* 2. Is your firm a member of the Life Care Planning Law Firms Association?

Yes

No

Don't know

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* 3. Please tell us which operating system (e.g., Windows 10, Mac, etc.) and internet browsers you use most often (Firefox - preferred, Chrome, IE, Safari, etc.).

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* 4. Please provide any questions or comments you might have here. Click the SUBMIT button when you are ready to submit your application. Once your eligibility is verified you will receive a confirmation e-mail from us with a registration link and instructions for payment. (This may take a few days).