SENIOR MATTERS
Transcription
SENIOR MATTERS
January 16, 2015 SENIOR MATTERS A Multidisciplinary Approach to Elder Care Registration Brochure KEYNOTE LINDA EVANS Aging Gracefully ANDY LANDIS Elusive Social Security Secrets Highline College Highline Student Union Building 2400 S. 240th Street Des Moines, WA 98198 RAJIV NAGAICH, JD LLM Why Traditional Planning Will Fail So Many Seniors 6.5 Continuing Education Credits applied for Guardians, Attorneys, CPAs, Social Workers and Nurses. Schedule 8:00 – 9:00 a.m. 10:45 a.m. – 12:00 p.m. Welcome - Traditional Planning is a Recipe for Disaster for Many Retirees. What are the Issues and Why Traditional Planning Will Fail So Many Seniors. Break Out Sessions: Speaker: Rajiv Nagaich, JD LLM 9:15 - 10:30 a.m. Break Out Sessions 1. Having the right Medical Team – Case for including Geriatricians Speaker: Marty Levine, MD Case-based discussion about the knowledge, skills, and attitudes of an effective primary care medical team. 2. Collaboration Creates Great Outcomes for Care: Resources to Help Your Clients Successfully Age in Place Speakers: Stan McKenzie, Janet Smith, Esq., Amy Egtvet, Mary Lynn Pannen, RN, BSN, CCM, and Shawn D’Amelio – Moderator – Lisa Mayfield This panel session will explore the professional support systems available in the community to support older adults in their homes. The panel will include an elder law attorney, fiduciary, home care agency, care manager and physical therapist. 3. Social Security Secrets Speaker: Andy Landis Take your Social Security knowledge to the next level. Unlock the mysteries of advanced filing strategies. Learn how and when to use File and Suspend and Spouse-only claims to increase lifetime payouts by thousands of dollars. 10:30 – 10:45 a.m. Refreshment Break with Exhibitors Aging in Place, “It’s More Than a Grab Bar” Speaker: Natalie Anderson, OTR/L, CAPS AARP reports that Americans overwhelmingly prefer to remain in their homes as they mature, yet only one in six homeowners have made any modifications. Learn three key components for maintaining safety, function, and independence in your home as you age. You may be surprised at what you learn. Hint: “It’s more than a grab bar!” 4. Regulatory Challenges in a MultiDisciplinary Practice Speaker: Tom Fitzpatrick, Esq. & Greg McBroom, Esq. Attorneys providing services beyond legal services can be on a perilous path unless you know the rules of the road. The session will explore the challenges lawyers face when they offer services that are not strictly legal services and what they need to do to avoid running afoul of the BAR rules. The speakers will also shed light on restrictions placed on medical professionals who may want to offer ancillary services that are not strictly medical in nature. 5. Crisis Planning – Medicare, Medicaid and VA. Speaker: Julianne Kocer, Esq. The session will provide attendees an overview of how long term care expenses are addressed and how Medicaid and VA programs can be utilized to help defray some of those costs. 12:00 – 12:30 p.m. Break with Exhibitors 12:30 - 1:30 p.m. 3:15 – 4:30 p.m. Luncheon & Key Note Speaker Break Out Sessions: Aging Gracefully – Living Your Best Life and Life Lessons! 1. The Preventative Care and Possible Reversal of Dementia in Older People Speaker: Jerry Mixon, MD Speaker: Linda Evans Normal aging is accepting the progressive decline in physical and mental capacity that normally accompanies aging. This is not how it needs to be. Dr. Mixon will review the changes in medicine that make it possible for most people to get ahead of illnesses and avoid the problems that come with ‘normal’ aging. It is a unique perspective that can help Americans get a second chance at a better life in later years. 1:30 – 2:45 p.m. Break Out Sessions: 1. Dementia and End of Life Speaker: Mimi Pattison, MD Explore the many dimensions of dementia and the major health care challenges at the end of life. Learn how to create a comprehensive approach to dementia care over the entire course of the disease. 2. Stop Winging It! Help Your Clients Really Understand Their Long-Term Care Options Speaker: Jullie Gray, MSW, LICSW, CMC This session will explore the continuum of long-term care options and discuss why the level of care matters. We will discuss pros and cons of various options and review the costs of each option 2. Long Term Care Insurance – Its Many Forms & Is It Worth It? Speaker: Brian Ott, CLTC, CLA 3. When a Guardianship is Necessary: Is a Guardianship Necessary? Learn what Long Term Care insurance really covers, when it is the best time to buy it and what main factors determine rates. Speaker: Beth McDaniel, Esq. & Mindi Blanchard, M.Ed, CPG 3. Non Crisis Planning – How Preplanning Can be the Difference This section will clarify what a guardianship is and is not; and when a guardianship is truly necessary. Discussion will focus on issues surrounding the need for a guardianship, ways to avoid a guardianship, and how designating an attorney-in-fact can avoid a guardianship. Speaker: James Bates, Esq. The session will review the inadequacies of traditional estate planning and will provide attendees a glimpse to how proper legal planning can go a long way in securing assets, helping minimize burdens left on family member and defining a path to avoid institutional care. 2:45 – 3:15 p.m. Break with Exhibitors 4:45 - 5:15 p.m. Closing Remarks: Pulling it All Together Speaker: Rajiv Nagaich, JD, LLM 5:30 – 6:30 p.m. Optional Networking Event Speakers Natalie Anderson, OTR/L, CAPS As an Occupational Therapist for 26 years, Natalie has been providing services for individuals with diagnoses such as stroke and Parkinson’s disease, and for individuals with functional deficits as a result of injury or musculoskeletal disorders such as chronic back pain. Her experience spans all continuums of the healthcare setting including acute hospital settings, inpatient and outpatient rehabilitation, skilled nursing facilities, and the home health setting. She has completed her certification as an Aging in Place Specialist to consult with building and design professionals providing insight and knowledge about function and independent living. In addition, Natalie completes individual client function and safety assessments providing solutions to assist with care planning and management. James Bates, Esq. Elder Law Attorney James C. Bates, located in our Edmonds office, represents Johnson & Nagaich’s north Puget Sound clients. He recently moved to the Pacific Northwest after practicing elder law and estate planning in Ohio for more than 15 years. Jim is a 1997 graduate of the University of Akron School of Law, and is licensed in both Washington and Ohio. In 2010, Jim appeared before the Ohio Supreme Court challenging the State’s collections practices with regard to estate recovery, and has also written on the topic for the Ohio State Bar Association’s “Law You Can Use” series. An accredited attorney with the Department of Veterans Affairs, Jim is also a member of the National Academy of Elder Law Attorneys and the Washington Academy of Elder Law Attorneys. Jim is passionate about helping families navigate the future, saying, “In my own household, we have a child with autism who may never live independently, so I understand first-hand how important it is to plan ahead and do it well, not only for this generation, but for the ones to follow.” Jim assists clients with LifePlanning, Medicaid planning, qualifying for VA Aid and Attendance benefits, and establishing special needs trusts, as well as estate planning and probate proceedings. Away from the office, Jim is an aviation writer, a private pilot, a hockey fan, and a voracious reader. He lives with his family in Bellevue. Mindi R. Blanchard, M.Ed., CPG Ms. Blanchard holds a bachelors degree in Health Education from Central Washington University and a master’s degree in education with an emphasis in counseling from City University. She was certified as a professional guardian in 2002 and in 2003, she founded Bridge Builders, Ltd, where she is President and owner. In 2008, she contracted with the State to provide guardianships through the Public Guardianship Pilot Project. In 2011, she was a finalist for the Small Business Association’s Small Business person of the Year Award, having been nominated by her business advisor. Since 2004, she has provided continuing education events for certified professional guardians starting with an annual two-day conference. In 2014, in response to requests from certified professional guardians in Eastern Washington, provided a two-day conference which will has been requested as an annual event. She also offers a variety of seminars and online trainings throughout the year. While Bridge Builders, Ltd is a certified professional guardian agency, she and her staff also provide care management, fiduciary services from basic bill pay to trustee, can be designated as a power of attorney and personal representative of the estate as well as consulting services with the goal of helping to avoid the need for a guardianship. Bridge Builders, Ltd offers a membership program for local residents who need a local emergency contact where she and her staff are on-call for the members 24/7 for urgent needs. Ms. Blanchard started a non-profit, The Guardian Institute, in 2013 with the goal of providing much needed resources to lay and professional guardians. Ms. Blanchard was a speaker for the 3rd World Congress on Adult Guardianship, which was held in Arlington, Virginia in May 2014. She is a member of the National Guardianship Association and the National Association of Geriatric Care Managers. Shawn D’Amelio Before joining With a Little Help, Shawn worked as a private care manager for a client with Alzheimer’s disease. This experience, as well as her ongoing journey with her own mother’s struggles with dementia and various health issues, led her to With a Little Help where she enjoys working with a team of caring professionals dedicated to providing excellent care with the personal touch she values. As a Client Assessment Specialist Shawn enjoys the process of bringing resources and people together, creating relationships that give peace of mind to families and their loved ones. In her role as the Director of Business Development she is guiding With a Little Help’s growth while keeping Marcia’s vision in sight, making sure that every client and employee is treated with respect and dignity. Growing up in the Great Northwest, Shawn enjoys outdoor activities like camping, horseback riding, hiking, river rafting and gardening. She has a passion for combining food, family, friends and fun. Amy Egtvet Amy Egtvet’s career began with non-profit and small business administration. Prior to becoming a Principal at WEA she worked at the Pacific Science Center and as Executive Director of Hostelling International, Washington State. She has worked extensively in developing budgets, keeping books for small business and managing offices. Amy excels at problem solving, detail oriented tasks and enjoys assisting individuals and families piece together their unique financial picture. She collaborates with the client and their advisors including attorneys, accountants, financial planners and geriatric care managers to research and reveal assets and spending patterns so that decisions can be made for estate planning and care of the individual. Linda Evans Photo courtesy ITV/Rex Features Award-winning actress Linda Evans has personified beauty and grace to American television viewers for over five decades, from her role as Audra Barkley on The Big Valley, to the glamorous Krystle Carrington on Dynasty, to Hell’s Kitchen, which she won in 2009 in London, England. She has won the Golden Globe Award for Best Actress in a Television Drama series and has won five People’s Choice Awards for Best Female Performer. Linda was also nominated for an Emmy Award for Outstanding Lead Actress in a Drama Series. For her contribution to the television industry, Linda has a star on the Hollywood Walk of Fame. After Dynasty, Linda moved from Hollywood to the Pacific Northwest, where she began an extraordinary journey of self-discovery. She has returned to performing frequently, starring in the stage play, Legends, and winning the Hell’s Kitchen competition while working under Michelin-starred chef Marco Pierre White. Linda’s often lavish and luxurious life has rivaled Krystle Carrington’s. She has dined with queens and presidents, been romanced by the rich and famous, and today, what Linda treasures most is the wisdom she has gained along the way. Tom Fitzpatrick, Esq. J.D. - University of Chicago Law School, 1976. B.A. - University of Montana, 1973. Executive Director of Snohomish County, 2005-2006. Assistant Chief of the Snohomish County Prosecuting Attorney’s Office Civil Division, 1999-2004. Super Lawyer - Washington Law & Politics. Attorney: 1989-1999 - Stafford, Frey, Cooper. 1978-1989 - Karr, Tuttle, Campbell. Professional Associations: Board of Governors of the American Bar Association. ABA House of Delegates. ABA Standing Committee on Professional Discipline. King County Bar Association. Jullie Gray, MSW, LICSW, CMC Jullie is a principal at Aging Wisdom, a care management firm in Seattle, Washington. She combines three decades of experience in healthcare and aging, is an award winning care manager and is a Past President of the National Association of Professional Geriatric Care Manages. Jullie attended the University of Washington where she completed a Bachelor’s degree in Social Welfare, Master’s Degree in Social Work with a Specialization in Healthcare, and a Certificate in Geriatric Mental Health. Jullie has been an Affiliate instructor for the University of Washington’s School of Social Work. She participates in local community advisory groups focused on aging. Speakers Julianne Kocer, Esq. Ms. Julianne Kocer is a Life Care Planning/Elder Law /Estate Planning attorney serving clients in the greater Seattle area. Julianne practices in the legal areas of Life Care Planning, Wills, Trusts, Medicaid, disability programs, Veteran Benefits and probate. She has a RN on staff to assist her in advocating for quality care. Julianne is an active member of the Washington State Bar Association and is also licensed to practice law in Minnesota. She received her J.D. degree from William Mitchell College of Law in St. Paul, Minnesota and her post-doctorate degree in Elder Law (“LL.M.”), with honors, from Stetson University College of Law in May 2013, a six year program covering all areas of elder law. Julianne is a frequent speaker on estate planning and long term care topics for continuing legal education credit seminars for attorneys and speaks often to other professional and community organizations. Additionally, she is a professor and guest speaker for the University of Washington Extension Program-Social Worker courses. She formerly served on the executive committee of the Elder Law Section of the Washington State Bar Association where she developed the Section’s first grant program. Julianne is also a member of the Life Care Planning Law Firm Association and of the National Academy of Elder Law Attorneys having served on the board of its Washington Chapter for five years in all board positions and as its Legislative Chair. Julianne has testified and written opposition papers against legislation negatively affecting seniors and disabled people. Her article titled, “Medicaid Planning for Our Seniors,” appears in the 2002 Educational Manual of Credit Professionals International and her additional publications can be seen in “SENIORguidebook.” She was named the 2004 NAELA Member of the Year by her fellow colleagues. Additionally, Julianne was named a “Rising Star” in Washington Law and Politics for six consecutive years in the December/ January 2004, 2005, 2006, 2007, 2008, and 2009 editions by the ‘SuperLawyers’ of Washington state, an award granted to only 2.3 percent of attorneys annually statewide who are under the age of 40 at the time the award is granted. Andy Landis Andy Landis is one of the nation’s foremost authorities on Social Security and Medicare, in demand nationwide as an author, speaker, and consultant. Andy has guided tens of thousands to abundant retirements while working at the Social Security Administration, AARP, multi-national corporations, and his own practice, Thinking Retirement. Through Thinking Retirement, Andy educates both individuals and financial professionals through live workshops, books, articles, webinars, and professional education courses. He is the author of the books Social Security: The Inside Story and When I Retire, available from Amazon. He is a regular blogger for the Wall Street Journal’s “MarketWatch” site. On TV, he has appeared on Fox Business News and PBS, and is a frequent guest on radio. Andy lives in Seattle with Kay, keyboards, camper, computers, cars, and sometimes kids. Marty Levine, MD Marty Levine, MD, is a family physician and geriatrician and the medical director of Iora Primary Care in Shoreline. He has been a primary care physician in the Puget Sound region for more than 17 years, working both as a clinician and a leader in redesigning clinical services for older adults. He is a multi-year “Top Docs” award winner in both Seattle and Seattle Metropolitan magazines. Stan McKenzie Stan has served in the Senior Housing business since 1998. He was a product manager setting up assisted living memory communities throughout the United States, national lecturer on memory loss, and a Community Relations Director for a retirement/assisted living community prior to starting A Change is Afoot (the name is from Sherlock Holmes) Senior Housing consulting firm in 2005. For 7 years he was caregiver for his own Mom. He is currently contracted with several hundred wonderful Retirement/Assisted Living Communities; Adult Family Homes; and “destination” housing opportunities. They pay his fees, not the client. Stan’s started his career in the Navy Hospital corps in Japan during the Viet Nam War. Working in orthopedics, he cared for the very recently wounded where he began to focus his life in “helping others to help themselves.” Stan went on to graduate from Stanford University’s Orthopedic Physician’s Assistant program and into an orthopedic practice before he started his own firm “Human Technologies” doing research, development, and marketing of orthopedic implants and physical rehabilitation equipment. When he sold his company, he found a new life path, working with seniors. Stan’s Community Volunteer Service includes; Current President of the Association of Senior Housing Professionals; American Red Cross First Responder local and U.S. Areal Team Captain; Past-President of Senior Care Coalition; and Past President for Rotary Club of Lynnwood – Seven Time Paul Harris Fellowship recipient; Past Regional Director of Y’s (YMCA) Service Club Intl. (Golden Book of Lifetime Accomplishments); Life-time member of “Who’s Who on the World”. Stan’s comment to all of this: “who cares? It is what I do today that counts!” Lisa Mayfield Lisa Mayfield, is the co-owner of Aging Wisdom, Inc. a geriatric care management and home care company in the Seattle area. Lisa has been working with seniors and their families for nearly two decades. She is a licensed mental health counselor, geriatric mental health specialist, certified care manager and has been named a fellow. Lisa currently serves as the Past-President of the Western Chapter of the National Association of Professional Care Managers (NAPGCM), serves on the NPAGCM board , is an active Rotarian, and is a long-time volunteer support group facilitator with the local Alzheimer’s Association. Greg McBroom, Esq. Greg McBroom is an experienced trial court attorney. His practice is primarily focused on general and complex civil litigation and appeals. He has obtained numerous successful jury verdicts and trial court decisions. He represents clients in many types of lawsuits such as contracts, healthcare, class actions, business and corporate law, real estate, disability and elder law, and construction. He provides legal representation to many clients seeking relief from actions taken by State and federal agencies, such as cases before the Department of Health, the Department of Social and Health Services, and the Board of Tax Appeals. He maintains an active appellate practice for protecting and defending the legal rights of his clients. In his healthcare practice, Mr. McBroom’s represents many healthcare businesses and practitioners including public hospital districts, non-profit hospitals, physicians and physician groups, dentists and dental groups, nursing homes, and long-term care facilities. He commonly provides representation in matters concerning the complex laws and regulations governing healthcare. This includes Medicare and Medicaid compliance and billing, contracting, Stark and Anti-Kickback, HIPAA, medical staff and credentialing issues, qui tam actions, certificate of need and other healthcare licensing matters, and employment issues. Many of Mr. McBroom cases have involved abuses by the government and large corporations, leading to some of the largest jury verdicts in Washington history and important changes in the law. Mr. McBroom’s practice is designed to mitigate the stresses and impact of litigation disputes so his clients can focus on their businesses. Mr. McBroom has also been called upon to act as an arbitrator and mediator in many types of cases including real estate, business and corporate disputes, medical malpractice, contract, personal injury and others. Beth McDaniel, Esq. Beth is the principal of the Law Offices of Beth A. McDaniel, PLLC, with a legal practice in the areas of guardianship, elder law, probate, and estate planning. Originally from Snohomish, Beth is a graduate of the Pepperdine University School of Law, where she also obtained a certificate in distribute resolution from the school’s renowned Strauss Institute for Dispute Resolution. Beth has been a member in good standing of the Washington State Bar Association since 1995. She is a past president of the Washington Academy of Elder Law Attorneys, was that organization’s 2006 outstanding member of the year, and currently serves as the organization’s president elect. In 2005, Washington Law and Politics Magazine named Beth as a Rising Star. Beth is a past chair of the King County Bar Association’s Guardianship and Elder Law Section. Along with serving on the King County Guardian ad Litem registry since 2000, Beth currently serves as a co-chair of the annual Inter-County Guardian ad Litem Training. Jerry N. Mixon, MD Born August 28, 1947 in Patuxent River Maryland. High school RA MILLIKAN in Long Beach CA, Graduated June 1965. US Army Airborne 1965-1968. California State University at Long Beach 1968 to 1970. University of Utah 1970 to 1972 graduated with a bachelor of science in microbiology. University of Utah College of medicine 1972 to 1976, M.D. Medical College of Wisconsin internship and residency in family practice at St. Michael’s Hospital, Milwaukee, Wisconsin 1976 to 1979. Private practice in Preston Idaho 1979 to 1986. Board-Certified family practice 1979. Private practice Shelton Washington 1986 to 1998. Also Preceptor University of Washington, physicians assisting students. Medical Director at Longevity Medical Clinic 1998 to present. Rajiv Nagaich, JD, LLM Rajiv Nagaich, an elder law attorney and senior partner with the Law Firm of Johnson and Nagaich PS, has developed a holistic legal practice that focuses on elder law and care issues which include legal, housing, financial, and health disciplines. Rajiv graduated cum laude with law degree from Seattle University School of Law, and then went on to earn his master’s degree in tax law from University of Washington. He is a member of the American Bar Association, Washington State Bar Association and Pierce County Bar Association. He sits on the Elder Law Advisory Board of John Marshall Law School in Chicago Illinois. He sits on the Board of the Washington Academy of Elder Law Attorneys, a founding member and past president of the Life Care Planning Law Firms Associations and an active member of the National Academy of Elder Law Attorneys. At the community level, Rajiv is the founder of Washington Elder Care, a non-for-profit corporation that serves the needs of the elderly in the Puget Sound area. He is an active member of the Rotary Club of Federal Way and a community educational instructor and speaker on estate planning and elder care issues. He is the host of a popular call-in radio talk show (AgingOptions) that airs live in the greater Seattle area every Saturday morning from 10 a.m.-Noon on KTTH AM 770. The show also airs live nationwide via streaming audio (http://agingoptions.com/media/radio-show/). Its two hours packed with a wealth of information and current news on aging options, as well as helping callers find better solutions for their elder/aging issues. Speakers Brian Ott, CLTC, CLA Brian Ott, CLTC, CLA is a Certified Long-Term Care Specialist, and founder of 525 Advisors LLC. As an independent company, 525 Advisors specializes in long-term care planning and works with all the major insurance companies offering various programs. Brian is also a Certified Agent for the 3in4 Need More Association which is a non-profit association formed to provide education and informational resources to raise national awareness for the need to develop a long-term care plan. Brian has developed an educational approach to helping people put a long-term care plan in place and is well versed in the various types of plans available including; Asset Based, Linked Benefits, Traditional Risk Based and State Partnership Programs. Brian is also well versed on the tax benefits due to recent changes in the Pension Protection Act and how they play a part in setting up a qualified long-term care plan as well as the many different approaches to funding a qualified plan. Brian has earned the CLTC designation which stands for “Certified in Long-Term Care”. CLTC graduates have completed a rigorous multidisciplinary course that focuses on the profession of long-term care planning. Mary Lynn Pannen, RN, BSN, CCM Sound Options’ CEO and President, Mary Lynn Pannen, is one of the nation’s leading experts on Geriatric Care Management and Home Care for seniors and individuals with complex and wide-ranging needs. A natural outgrowth of her work as a Registered Nurse (RN), certified care manager, and private consultant for nursing, geriatrics, and medical legal reviews, Mary Lynn based her vision for Sound Options on her more than thirty-five years of hands-on experience working as an advocate for patients and families. Since its founding in 1989, she has grown the company into the largest private elder care management company in Washington State. Mary Lynn is a well-known and resourceful voice on elder care issues. Actively contributing to her community, she has sat on advisory boards, authored articles, presented at conferences, and conducted interviews on numerous elder care and care management topics. Her expertise and passion for quality care has made her a sought-after speaker and advisor on both the local and national level. As a member of the National Association of Geriatric Care Managers since 1990, she has sat on the board and served as president of this prestigious organization. At their national conference she was awarded the 2008 Adele Elkind award for distinguished professional service in Geriatric Care Management. Locally, she is an active volunteer, a member of Tacoma Rotary 8 Club. Additionally, Mary Lynn serves on the South Puget Sound Boys and Girls Club board and the Washington State Private Duty Association board. Mimi Pattison, MD Dr. Pattison is currently Medical Director of Franciscan hospice and Palliative Care. She has been with FHS for 26 years. She is board certified in Internal Medicine, Nephrology , and Hospice and Palliative Medicine. Her special interest in hospice care is for patients with chronic mental illnesses including dementias. She was recently appointed to the Task Force that is creating a state Alzheimers Plan for the state of Washington. She also has serviced on the Medical Quality Assurance Commission since 2008 when she was appointed by Governor Gregoire. Janet L. Smith, Esq. Janet L. Smith, founder of Northwest Elder Law Group PLLC is an attorney providing services in elder law, estate planning, estate administration, guardianship, and elder mediation. She has been an attorney in good standing, licensed in the State of Washington, since 1983. She received her law degree from the University Of Washington School Of Law in 1983, and received a Certificate in Gerontology from the University of Washington in 2000. She completed the Professional Mediation Skills Training Program through the University Of Washington School Of Law in 2008. In 1997, she was a founder of Elder Care Solutions, Inc., providing geriatric care management, consulting, and certified professional guardian¬ship services through 2005, during which time she was a member of the National Association of Professional Geriatric Care Managers, serving on their Western Chapter Board. She has been appointed as a Guardian ad Litem numerous times in both King and Snohomish Counties, and has served as a trained facilitator for an Alzheimer’s disease caregivers’ support group. She is a member of the National Academy of Elder Law Attorneys (NAELA) and the Washington Chapter of NAELA, the Washington State Bar Association Elder Law Section, the Washington State Bar Association Alternative Dispute Resolution Section, the King County Bar Association Guardianship and Elder Law Section. She is a frequent speaker on elder law topics. Registration Name (as it should appear in print): ________________________________________ Designation:_________________ Company Name / Firm: _____________________________________________________________________________ Phone: _____________________________________ Fax: _________________________________________________ Email (required): ___________________________________________________________________________________ Mailing address: ___________________________________________________________________________________ City: _____________________________________ State: ________________________ Zip: ______________________ Payment Information: o M/C o AMEX o VISA o Check Enclosed - Made Payable to WAELA. Credit Card #:_________________________________________ Exp Date: ____________ CVV Code: ______________ Signature: ________________________________________ Name on Card: ___________________________________ Billing Address: ___________________________________________________________ Zip: ____________________ REGISTER NOW & SAVE! Early Bird Rate: $150 After December 19, 2015: $199 HOTEL RESERVATION A block of rooms has been reserved at the Best Western in Kent, WA. Call (253) 854-8767 or toll free at (877) 446-0844 to make reservations over the phone. Please refer to the Senior Matters 2015 conference. $89/night, January 15 and 16, 2015 QUESTIONS?: Call Susan Crolla (850) 656-8848 or email [email protected]. PLEASE SEND COMPLETED FORMS TO: WAELA, PO Box 13978,Tallahassee, FL 32317; or FAX to: (952) 252-8096. CANCELLATION POLICY: All cancellations must be received prior to January 1, 2015. Refund is amount paid less $50. No refunds after January 1, 2015.