ONIG Education Day at Peterborough Regional Health Centre, June 14, 2010
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ONIG Education Day
LOCATION: Peterborough Regional Health Centre
DATE: June 14, 2010
1
. First Name (this will appear on your name tag)
First Name (this will appear on your name tag)
2
. Last Name (This will appear on your name tag)
Last Name (This will appear on your name tag)
3
. Email Address
Email Address
4
. Telephone
Telephone
5
. Organization/ Place of Employement (this will appear on your name tag)
Organization/ Place of Employement (this will appear on your name tag)
6
. Title and Credentials
Title and Credentials
7
. Are you an ONIG member?
Are you an ONIG member?
Yes
No
Don't know...
8
. Are You a RNAO e-HEALTH Champion?
Are You a RNAO e-HEALTH Champion?
Yes
No
9
. Will you be attending the Education Day...
Will you be attending the Education Day...
Via Videoconference(OTN)
Via Webcast
In person
In person as an executive guest
If guest enter ONIG Executive Name
10
. Dietary/allergy Restrictions?
Dietary/allergy Restrictions?
No
Vegetarian
No pork
other dietary allergies..?
11
. How did you hear about the Meeting? (choose all that apply)
How did you hear about the Meeting? (choose all that apply)
ONIG distribution or event
RNAO distribution or event
CNIA distribution or event
Word-of-mouth
Email forward
Other (please specify)
*
12
. Network Information
Network Information
I agree to publish my name and demographic information
I agree ONIG may take and use my picture for ONIG related purposes
Do not publish my network information
I do not agree to the use of my picture and I will advise ONIG at registration
13
. Do you have any suggestions/advice for ONIG in regards to future events you would like to see, or improving future ONIG events?
Do you have any suggestions/advice for ONIG in regards to future events you would like to see, or improving future ONIG events?
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