|
You can use your browser's "print" function to make a copy of this form. Then you can fill it out by hand and mail it to:
Coalition of Wisconsin Aging Groups Please make your check or money order payable to "CWAG." Thank you! |
|
Name: |
|
Address (incl. city, state, zip):
|
|
Telephone: |
Write in the number of each item you wish to order. Remember that underlined publications can be viewed on-line simply by clicking on the title.
| Publications of General Interest | ||
|---|---|---|
| Title | Number Requested | Unit Price |
| Leadership Guides |
|
$5.00 |
| Aging in Wisconsin |
|
$5.00 |
| Long Term Care in Wisconsin |
|
$5.00 |
| CWAG History |
|
$1.00 |
| CWAG Pins |
|
$2.00 |
| Advocate |
|
$.55 |
| Action Alert |
|
Free |
| From the Elder Law Center | ||
| Title | Number Requested | Unit Price |
| Elder Rights & Benefits Booklet |
|
$7.00 + postage |
| Consumer Self-Help Kit for Medical Assistance and Estate Recovery Program |
|
$5.00 |
| Guardianship Newsletter (quarterly) |
|
Free |
| Please Submit a Self-Addressed, Stamped Envelope to Receive the Following Items | ||
| Title | Number Requested | Stamp Amount |
| Lien Law/Estate Recovery |
|
.55 |
| Spousal Impoverishment |
|
.32 |
| Power of Attorney for Financial |
|
.32 |
| Power of Attorney for Health Care and Living Will |
|
.78 |
| Free Brochures | ||
| Title | Number Requested | Unit Price |
| Guardian of the Person |
|
Free |
| Guardian of the Estate |
|
Free |
| Guardian as Advocate |
|
Free |