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June 2016 Event Registration Form Mail or bring to: Golden Opportunity Golden Opportunity 1401 Jefferson Highway New O...

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June 2016 Event Registration Form Mail or bring to: Golden Opportunity

Golden Opportunity

1401 Jefferson Highway New Orleans, LA 70121 504-842-7000 NAME:

Home Phone: ___________________________ Cell Phone: _____________________________

Address:

City, State, Zip:

Important Notes: Effectively Immediately 1. 2.

3.

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Please send in the Event Reservation Form with your payment. All prices are listed are per person. If you register to attend an event on the registration form please note that all events will be NONREFUNDABLE (includes the ($5) NONREFUNDABLE transportation fee). If someone is on the waiting list, we’ll request that person make the check payable to you, send it to our office and we will forward the check to you. A credit will no longer be issued. If an event requires payment by check, submit separate checks for each event unless you are paying for more than one person for the same event. Please put the event name on the bottom of the check as some events have the same cost. Please SIGN your check. When attending “LUNCH BUNCH” please be prepared that this event will not return to the Primary Care & Wellness Center until event is over (approximately 2:30 p.m.). Please do not sign-up for this event if you have “Schedule Conflicts”! Lunch Bunch - “Antoine’s Summer Lunch Special – Limited to a group of 15 guests per day $36.00 per person (Includes Lunch Buffet & Ochsner Bus Fee) Departure: 11:00 a.m. – GO Office (Center for Primary Care & Wellness Building) Please number your choice from #1 to #6 rd June 3 , Friday _______ th June 8 , Wednesday _______ th June 13 , Monday ________ st June 21 , Tuesday ________ th June 24 , Friday _________ th June 30 , Thursday ___________ th

June 7 (Tuesday): Members’ Monthly Meeting 10:00 a.m. – 11:30 a.m. – Brent House – Caldwell & LeJeune Rooms Light refreshments provided! □ attend □ will not attend th

June 9 (Thursday): Members’ Monthly Potluck (Bring a prepared or purchased food and socialize with other members) 12:00 p.m. – 1:30 p.m. - Brent House – LeJeune Room □ attend □ will not attend th

June 10 (Friday): Houmas House Plantation Tour & Buffet Lunch $60.00 per person (Includes tour, lunch and motorcoach transportation) Departure: 10:00 a.m. – Return: 2:30 p.m. GO Office (Center for Primary Care & Wellness Building) □ attend □ will not attend th

June 16 (Thursday): Seminar - “Stroke Warning Signs and Prevention” Presented by: John Reilly, MD - Cardiology 10:00 a.m. – 11:30 a.m. – Center for Primary Care & Wellness - Camellia Room Light refreshments provided! □ attend □ will not attend

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June 2016 Event Registration Form Golden Opportunity

NAME:

Home Phone: ___________________________ Cell Phone: _____________________________

Address:

City, State, Zip: _________________________ nd

June 22 (Wednesday): “Viewing of the Panama Canal Experience – History, Culture, Onboard and Shore Excursions Experiences” – Limited to 40 attendees for this session 10:00 a.m. – 11:30 a.m. – Center for Primary Care & Wellness - Camellia Room Light refreshments provided! □ attend □ will not attend th

June 29 (Wednesday): Seminar – “MyOchsner” – Easy access to your medical information (scheduling appointments, communication with your physicans and test results) Presented by: Michelle Espina - Ochsner Patient Portal 10:00 a.m. – 11:30 a.m. – Center for Primary Care & Wellness - Camellia Room Light refreshments provided! □ attend □ will not attend

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May 17 (Tuesday): Event Registration - GO Office (Center for Primary Care & Wellness) If unable to attend, mail in your Event Registration Form and a separate check for each event payable to “Golden Opportunity” with the event name in the memo section of your check.

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