Step 1 of 3:

Which best describes you?

Please choose one of the following:

Tell us why you are applying for a Care Chair.

I work at or reside in a senior care facility.

I work at or reside in a rehabilitation facility.

I work in public safty as a police officer or firefighter.

I work in or with a hospital or clinic.

I work at or reside in a hospice care center.

I work in City, State or National Government.

I have a medical practice and need it for my patients.

I have a medical condition that causes severe pain

I am an educator at a school or university

Other - None of the above

We respect your privacy.
We will never share or sell your personal information.