Preceptor Workshop Registration Form

Date of Workshop:

Chipman Building Auditorium April 22, 2022 8:30 a.m. - 4:30 p.m. - Closed-
Yarmouth Regional Hospital - Bluenose Conference Room April 22, 2022 8:30 a.m. - 4:30 p.m.
Aberdeen Regional Hospital - 1st floor, Boardroom April 27, 2022 8:30 a.m. - 4:30 p.m.
Yarmouth Regional Hospital - Bluenose Conference Room April 29, 2022 8:30 a.m. - 4:30 p.m.
Yarmouth Regional Hospital - Bluenose Conference Room May 6, 2022 8:30 a.m. - 4:30 p.m.
Yarmouth Regional Hospital - Bluenose Conference Room May 10, 2022 8:30 a.m. - 4:30 p.m.
Fisherman's Memorial Hospital - Founders Room May 13, 2022 8:30 a.m. - 4:30 p.m.

* 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:

Email:

Professional Designation:

Other:

Facility:

Practice Setting:

Health Services Manager Name:

Health Services Manager Email:

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