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 refunds will be given for cancellations less than 20 business days (4 weeks) of the course date or for no-shows. If more than 20 business days (4 weeks) of the course date, cancellations will result in a refund, minus a $20 administrative fee, payable upon return of the course manual to the NB Trauma Program.
Applicant Information (all spaces must be completed)
Name: / Employee ID:
Title/Position: / E-mail:
Home Phone: / Work Phone:
Facility: / Department:
Horizon Vitalité other for Horizon or Vitalité, please indicate area1 2 3 4 5 6
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
February 22-24, 2017 / Oromocto Public Hospital / September 27-29, 2017 / Saint John Regional Hospital
April 26-28, 2017 / Miramichi Regional Hospital / October 11-13, 2017 / Edmundston Regional Hospital*
May 2-4, 2017 / Saint John Regional Hospital / October 23-25, 2017 / Dr. Everett Chalmers Regional Hospital
May 17-19, 2017 / Edmundston Regional Hospital* / November 1-3, 2017 / Dr. Georges-L. Dumont Hospital*
June 12-14 2017 / The Moncton Hospital / November 15-17, 2017 / The Moncton Hospital
June 14-16, 2017 / Chaleur Regional Hospital*
Registration Fees:
Full Course (NENA Member) - $200 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 toHorizon Health Network (attention: NB Trauma Program) through bank transfer orby 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:
orfax 506-648-6799
for use by horizon learning
Acceptance into Program: / Yes No Wait List
Applicant Sent: Welcome Letter Textbook Receipt (if applicable) / Sent via: Internal Mail Courier
Date Sent: / Courier Tracking Number:
Registered in Database: / Yes No / Entered by:
*Francophone instructors available for course