CAPCE

COMPREHENSIVE ADVANCED PALLIATIVE CARE EDUCATION
Registration Form

* Indicates required field

Name *

First

Last

Email Address of Participant *

Phone Number *

Place of Work *

Job Title / Discipline *

Location:
629 Markham Rd. Unit 2
Room: Elderly Person Centre - Lower level of Greenholm Circuit

Choose One *

September 12th, 2019 – January 23rd, 2020 from 4:30 – 8:30 pm

CAPCE Selection Criteria: a minimum of 1 year hospice palliative care nursing experience, have access to an internet-enabled computer, have knowledge of basic computer programs, and have completed the Fundamentals of Palliative Care course.

I have a minimum of 1 year validated full time palliative care nursing experience. *

Yes - Please proceed to payment No – Please do not proceed to payment

I give my consent to be contacted regarding SCHC’s Palliative Education & other programs *

Yes No

If you have any physical, mental or invisible disabilities, is ther anything we can do to accomodate you ? *

Yes No

Please Specify *

FEE: $300.00 Payment is required upon registration. A spot will not be held until payment is made.
Only Visa and Master Card are accepted. AmEx or Visa Debit are not accepted

Payment

COMPREHENSIVE ADVANCED PALLIATIVE CARE EDUCATIONRegistration Form

Scarborough Centre for Healthy CommunitiesCharitable # 13036 4276 RR 0001

COMPREHENSIVE ADVANCED PALLIATIVE CARE EDUCATION
Registration Form

Scarborough Centre for Healthy Communities
Charitable # 13036 4276 RR 0001