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Preceptor Workshop Registration Form

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Date of Workshop:

 

  • Aberdeen Hospital Boardroom October 20, 2021 (Northern Zone)

  • South Shore Regional Hospital Lecture Rooms 1, 2, 3 November 4, 2021 (Western Zone) - Registration Closed

  • Yarmouth Regional Hospital Bluenose Conference Room November 22, 2021 (Western Zone)

  •  Chipman Building Auditorium November 24, 2021 (Western Zone)                                                                       

* To register for Cape Breton area workshops click here.

*To register for workshops based in St. Martha's please email Julia.Kolanko@nshealth.ca

*To register for workshops based in Central Zone please email Brenda.Dunphy@nshealth.ca.

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First Name (This is the name that will appear on your certificate):

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Last Name (This is the name that will appear on your certificate):

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Home Phone:

Work Phone:

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Email:

Professional Designation:

 

Health Authority:

NSHA - Eastern NSHA - Central NSHA - Northern NSHA - Western IWK

Other:

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Facility:

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Practice Setting:

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Health Services Manager Name:

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Health Services Manager Email: