This program is sponsored by Maine Coast Memorial Hospital in conjunction with the Downeast YMCA. This is an 8 week course. It meets on Tuesday and Thursday mornings, from 10:30 to 11:30 AM. Registration is taken on a first come-first serve basis. Early registration is recommended.

Please print this form, then mail it along with you payment to:
  Downeast YMCA, State Street, Ellsworth ME 04605.

Name
Address (City, state, zip)
Phone (Home & business)
Type of Arthritis (if known)
Where did you hear about the Arthritis Foundation YMCA Aquatic Program?
Ethnic origin (optional)	Asian Black Hispanic Native American White Other____________________
Registration Fees:	Fees are based on your membership with the YMCA. Family Member: $25 Adult Member: $35 Non-member: $50 My fee of $_____ is enclosed. Please make check payable to Downeast YMCA.
Scholarships:	Full and partial scholarships are available to qualifying applicants. Please indicate here if you are interested in applying for a scholarship.