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Preceptor Workshop Registration Form


Date of Workshop:


  • 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)- Registration Closed

  • South Shore Regional Hospital December 7, 2021 (Western Zone)- Registration Closed 

  • Cumberland Regional Health Care Center December 8, 2021 (Northern Zone)- Registration Closed                                                                

* 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.


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


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


Home Phone:

Work Phone:



Professional Designation:


Health Authority:

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





Practice Setting:


Health Services Manager Name:


Health Services Manager Email: