Organization Registration

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

Organization/Group Name	Stearns Place - Washburne Court
Primary Phone	320.243.7451
Primary Email	joy.rausch@centracare.com
Address	311 Washburne Ave
Address Ln 2
City	Paynesville
State	Mn
Zip	56362

Individual Contact Information

First Name

Last Name

Cell Phone (Primary)

Phone (Alternate)

Department

Password (Minimum of 6 Characters)

Password (verify)

Cancel