TNCC Registration Policy: Pre-Registration is required. Course materials will be sent to the successful applicants 4 weeks prior to the course date provided full payment has been received.
Refunds: No refund will be given for cancellations less than 20 business days (4 weeks) of the course date or for no-shows. Refunds, less $20 administration fee, will be issued once the course manual is returned to NB Trauma Program.
Applicant Information (all spaces must be completed)
Name: / Employee ID:
Title/Position: / E-mail:
Home Phone: / Work Phone:
Facility: / Department:
1 Horizon 1 Vitalité 1 other for Horizon or Vitalité, please indicate area 11 12 13 14 15 16
Work Address (must include a street address for shipping materials): / ____ I am paying for the course myself (cheque sent).
____ I have been approved by my manager to attend
this program (signature required below).
Manager’s Signature: ______
Manager’s Name: ______
(please print)
REGISTRATION INFORMATION
Please put an X in the box beside the course you would like to attend:
Date / Location / Date / Location
May 17-19, 2016 / Saint John Regional Hospital / September 26-28, 2016 / Saint John Regional Hospital
June 1-3, 2016 / Edmundston Regional Hospital* / October 12-14, 2016 / Chaleur Regional Hospital*
June 6-8, 2016 / Dr. Georges-L. Dumont Hospital* / October 12-14, 2016 / Upper River Valley Hospital
June 6-8, 2016 / The Moncton Hospital / October 26-28, 2016 / Chaleur Regional Hospital
June 8-10, 2016 / Dr. Everett Chalmers Regional Hospital / November 2-4, 2016 / Dr. Georges-L. Dumont Hospital*
November 8-10, 2016 / The Moncton Hospital
Registration Fees:
1 Full Course (NENA Member) - $200 1 Full Course (Non-NENA Member) - $210
NENA member - # ______
Note: Course materials will only be sent when full payment and completed registration form are received. You will be notified via e-mail with confirmation of registration.
√ Send payments to Horizon Health Network (attention: NB Trauma Program) through bank transfer or by cheque to: Horizon Health Network Accounts Receivable, 400 University Avenue, Saint John, NB, E2L 4L2.
AND
√ Scan and E-mail your completed registration form to:
or fax 506-648-6799
for use by horizon learning
Acceptance into Program: / Yes No Wait List
Applicant Sent: 1 Welcome Letter 1Textbook 1 Receipt (if applicable) / Sent via: 1 Internal Mail 1 Courier
Date Sent: / Courier Tracking Number:
Registered in Database: / Yes No / Entered by:
*Francophone instructors available for course