Continuing Care Edmonton Zone Palliative Care Program Registration Information Professional Designation: Name: (MD, RN, LPN, etc.) Workplace Setting: Employer: (clinic, acute, homecare, etc.) Email: Contact Number: Workshop Dates, Locations & Time: April 17, 2015 (1:00 pm – 5:00 pm) & April 18, 2015 (8:00 am – 4:30 pm) Royal Alexandra Hospital Payment Information The workshop fee is $89.00. This fee includes workshop package and materials, refreshments served on the first half-day session and a continental breakfast, lunch and refreshments served on the second full-day session. Registration acceptance is dependent on payment of workshop fee. Registration is limited to a maximum of 60 participants. Confirmation of workshop registration will be sent via email once payment has been received. Payment must be made via cheque only. Please post-date your cheque to the date of chosen workshop and make payable to Alberta Health Services Please forward your payment to: Edmonton Zone Palliative Care Program #335, St. Marguerite Health Services Centre – Grey Nuns Community Hospital, 1090 Youville Drive West Edmonton, AB T6L 0A3 Please complete this registration form and email it to: @ info.ezpcp@albertahealthservices.ca www.palliative.org https://www.facebook.com/EZPCP
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