Preceptor Workshop Registration Form

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Date of Workshop:

• Colechester East Hants Health Centre - Willow Room February 10, 2022

• South Shore Regional Hospital - Lecture Rooms 1,2,3 Tuesday February 15, 2022                                                                 

* 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:

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: