Workshop Registration

Training Workshop Registration
CMP Project: Reducing Avoidable Hospitalizations Across the Continuum of Care in CMS Region IV
Please complete this registration form ahead of the scheduled training. All fields are required.
Indicate if you would like to receive 3 CEUs for participating.

First Name

Last Name

Credentials

(i.e. RN, MD, etc.)

Email Address

Name of Facility or Organization

Position at Facility or Organization

(i.e. NHA, DON, etc.)

City

State

Zip Code

Phone Number

Workshop Date and Location

Would you like to receive 3 Continuing Education (CEU) hours for attending this training?

Yes

*All fields are required