University of Massachusetts Medical School

Chief Resident Immersion Training (CRIT) in the Care of Older Adults

Cliff House Resort & Spa in Ogunquit, Maine
Friday afternoon, May 17th, through Sunday afternoon, May 19th 

Sponsored by Advancing Geriatrics Education (AGE): A UMMS educational initiative funded by the Donald W. Reynolds Foundation

REGISTRATION & RESERVATION FORM

PART 1 (of 3)

When you have completed the CRIT registration and room reservation information, click the Submit Information button at the bottom of this page. Your registration information will be sent to Colleen Burnham, UMMS CRIT.

Full Name*    
Street Address    
City/town    
State    
Zip code    
Pager Number    
Home/Cell Phone    
In what capacity are you attending UMMS CRIT?    
What is your sub-specialty?    
What is your Residency Program?    

     
Cliff House Reservation Information      
Will you be bringing your family or a guest?*    
Number of adults (including you)    
Number of children under 12 years    
*note If you plan to bring your family, please contact Colleen Burnham (UMMS CRIT) to provide more detailed reservation information      
Do you (or your guest(s)) have any dietary restrictions?    
Weekend Menu.......      
  CRIT Participant Entrée selection Guest Entrée selection  
   
~Sunday~ Breakfast Buffet (participants only) Boxed Lunch (participants only)      
Questions, Comments, Concerns...?    
  For additional CRIT program information For additional Cliff House reservation information  
  Gary Blanchard, MD Geriatrics Clinical Faculty UMMS Office of Educational Affairs Gary.Blanchard@umassmed.edu 508.856.4250 UMMS S1.143 Colleen Burnham, MBA UMMS CRIT UMMS Office of Educational Affairs Colleen.Burnham@umassmed.edu 508.856.5137 UMMS S1.165