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.)
Zip Code  
Phone Number  
Workshop Date and Location  
Would you like to receive 3 Continuing Education (CEU) hours for attending this training?  

*All fields are required