CMS’ Satellite Broadcast - Supporting Rural Family Caregivers Downlink Site Registration Form

Please register as a downlink site if you have a steerable satellite dish and are willing to downlink our satellite broadcast on March 19th, 1-3:30 PM (Eastern Time) and are willing to have members of the public contact you to view the broadcast at your facility.

As a registered satellite downlink site, we request that you allow other interested individuals to view the broadcast from your facility. Individuals in your area will be instructed to contact the person you designate to reserve a seat for the event.

Check if you are registering as a downlink site for viewing exclusively by the members of your organization
	Contact Name:
	Organization:
	Address:
	Address(2):
	City:
	State:	Zip:
	Phone:
	Alternate Phone:
	E-Mail:

Casals & Associates, Inc.
1199 N. Fairfax St. 3rd. floor
Alexandria, VA 22314
Tel. 703-920-1234
Fax. 703-920-5750
www.casals.com