Organization Registration

Please fill out form with necessary information and click the submit button below.

Organization/Group Name	Milestone Senior Living
Primary Phone	7154798018
Primary Email	managerer@milestoneseniorliving.com
Address	2332 railroad st.
Address Ln 2
City	Eagle river
State	WI
Zip	54521

Individual Contact Information

First Name

Last Name

Cell Phone (Primary)

Phone (Alternate)

Department

Password (Minimum of 6 Characters)

Password (verify)

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