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Arizona Telemedicine Training Registration
The fees
below are waived for Arizona Telemedicine Program Network members and
Arizona residents. Group discounts available. o June 11, 2008 (Phoenix) 9:00 a $300 o August 13, 2008 (Phoenix) 9:00 a $300 o October 8 & 9, 2008 (Tucson) 9:00 a $500 o December 10, 2008 (Phoenix) 9:00 a $300 o February 11 and 12, 2009 (Phoenix) 9:00 a $500 o April 8, 2009 (Tucson) 9:00 a $300 o June 10 and 11, 2009 (Phoenix) 9:00 a $300 o August 12, 2009 (Phoenix) 9:00 a $300 o October 7 and 8, 2009 (Tucson) 9:00 a $300 o December 9, 2009 (Phoenix) 9:00 a $300 Lunch is provided Total: ________ _______________________________________________________ Name/Title _______________________________________________________ Address _______________________________________________________ _______________________________________________________ Phone and Fax _______________________________________________________
Method of Paymento Check o Visa o MasterCard o Purchase Order # _____________________________________
_______________________________________________________ Credit Card # Exp. Date _______________________________________________________ Name as it appears on card Zip code _______________________________________________________ Signature
Area of Interest Specific Goals: o Clinical ___________________________ o Administrative ___________________________ o Educational ___________________________ o Technical ____________________________
Send registration form to:
Janae Cooley Fax: 602-827-2118
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Updated: May 8, 2007 |
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