Inpatient Obstetrics Review Course

note* : "For pdf of entire brochure, click on front cover of brochure."

REGISTRATION FORM
To register for this course,

Complete the form below and then click the "Register" button to send it to the Perinatal Cooperative.
Mail a check, payable to SNJPC, to:

Southern NJ Perinatal Cooperative
attn: Darlene Presson
2500 McClellan Ave., #250, Pennsauken, NJ 08109
856-665-6000 • (fax) 856-665-7711
PLEASE NOTE: This is a 2-day course offered at three different times.
See the bottom of the registration form for the dates and times this teleconference is offered.
Please be sure to select the date and time of the program you plan to attend at the end of the registration form.

Inpatient Obstetrics Review Course
October, 2007; February & May, 2008

            Name   

                    Preferred Mailing Address:

            Street  
              City   
             State    Zip 

        Home Phone  
        Work Phone  
               Fax  
            E-mail  

Agency/Institution  
             Title  


	
Check for Nursing Contact Hours


Specialty/Interest Areas (check all that apply)

Specialty		

Advance Practice
Cert Nurse Midwife
Office Nurse
Public Health
Other 

Interest Areas

Home Health Care
Obstetrics
Pediatrics
Other 

Please Select the Dates of the Program You Plan to Attend

Thursday & Friday, October 25 & 26, 2007
Saturday & Sunday, February 9 & 10, 2008
Tuesday & Wednesday, May 6 & 7, 2008

Questions? Please Call the Perinatal cooperative at 856-665-6000.