ONIG Education Day at Peterborough Regional Health Centre, June 14, 2010

ONIG Education Day
LOCATION: Peterborough Regional Health Centre
DATE: June 14, 2010

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* 1. First Name (this will appear on your name tag)

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* 2. Last Name (This will appear on your name tag)

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* 3. Email Address

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* 4. Telephone

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* 5. Organization/ Place of Employement (this will appear on your name tag)

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* 6. Title and Credentials

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* 7. Are you an ONIG member?

Yes

Don't know...

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* 8. Are You a RNAO e-HEALTH Champion?

Yes

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* 9. 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

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* 10. Dietary/allergy Restrictions?

Vegetarian

No pork

other dietary allergies..?

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* 11. 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)

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* 12. 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Do not publish my network information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

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* 1. First Name (this will appear on your name tag)

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* 2. Last Name (This will appear on your name tag)

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* 3. Email Address

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* 4. Telephone

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* 5. Organization/ Place of Employement (this will appear on your name tag)

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* 6. Title and Credentials

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* 7. Are you an ONIG member?

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* 8. Are You a RNAO e-HEALTH Champion?

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* 9. Will you be attending the Education Day...

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* 10. Dietary/allergy Restrictions?

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* 11. How did you hear about the Meeting? (choose all that apply)

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* 12. Network Information

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* 13. Do you have any suggestions/advice for ONIG in regards to future events you would like to see, or improving future ONIG events?