Let’s Talk about ACP Virtual Workshop Registration Form

Event: “The Let’s Talk about ACP” Advance Care Planning Virtual Workshop

Date:    Friday, Oct 16, 2020 12N-2PM

Sponsored by: Life Springs Consulting Group & The Center for Practical Bioethics

Event Description: In this free workshop, you will learn about healthcare decision-making through interactive activities facilitated by Elder Marisette Hasan and Dr. Gloria Anderson. To help us improve future workshops, we will ask you to participate in research by completing a pre-survey at the beginning of the webinar and a post-survey evaluation at the end. Completion of the survey is voluntary, and your responses will be anonymous. 

As a part of this event, *you will receive a free copy of “The African-American Spiritual and Ethical Guide to End-of-Life Care: What Y’all Gon’ Do With Me?” There will be door prizes and all participants will receive a certificate of completion.

If you have any questions, please contact Dr. Anderson or Elder Hasan directly:

Gloria Thomas Anderson, PhD, LMSW

Assistant Professor of Social Work

North Carolina State University

IRB#20582

Email: gtander2@ncsu.edu

Phone: 913-433-3877

Elder Marisette Hasan, BSN, RN

Chosen 2 Conquer International Ministries

2 Brittany Park Lane Columbia, SC 29229

Email: mhasan@cchospice.org

Phone: 803-509-1021

Please fill out this form to register for the event below. *You will need to provide a valid mailing address to receive your FREE Guide/workbook used for this event.  

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  • Your Mailing Address (to receive your Guide/Workbook to use in the event)
  • The event administrator will use this number to contact you if there are any issues with delivery of your Guide/Workbook*
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