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BP5 Hospital Decontamination Training Registration
June 12, 2017 through Friday June 16, 2017
**Please remember that mileage is offered for ONE member PER facility at a first come first serve basis.** PLEASE CARPOOL
*
1.
First and Last name
(Required.)
*
2.
Name of Organization/Agency
(Required.)
*
3.
Email Address
(Required.)
*
4.
Which session are you registering for?
(Required.)
Monday June 12: Munson Healthcare Charlevoix Hospital
Tuesday June 13: MidMichigan Medical Center Alpena
Wednesday June 14: McLaren Northern Cheboygan Campus
Friday June 16: Munson Medical Center
*
5.
What is your healthcare specialty?
(Required.)
Physician
Nurse
First Responder
Social Worker
Pharmicist
Local Public Health
Emergency Management
Nursing Home Administrator
MIlitary
Other
Other (please specify)
*
6.
Special dietary needs?
(Required.)
No
Yes
(please specify)
