Managing Patients in the Border Region

Managing Patients in the Border Region - Registration Form

Event Date: Friday-Saturday June 12-13, 2009

Registration Deadline: Friday, May 29, 2009

There is no fee for this course. Confirmations will be sent out June 3, 2009

Last Name

First Name

Credential

Organization

Address

City

State

Zip

Telephone

Fax

Email (REQUIRED; please be sure your e-mail is accurate)

Do you want MD CMEs?

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Yes

Do you want RN CEUs?

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Yes

License #

Please check which days and times you plan to attend

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Friday, June 12th: afternoon

Friday, June 12th: dinner/lecture

Saturday, June 13th: morning

Saturday, June 13th: afternoon

Check here if you need a vegetarian meal

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Pre-Event Focus Group

What Are Border Clinicians' Future Training Needs?

Friday, June 12, 1:00 - 3:00

The event sponsors are seeking border region clinicians to participate in a discussion focusing on unmet training needs. Participants will receive a stipend.

Please complete these additional questions if you are interested in participating:

Your Practice Setting

Do you currently provide care for HIV-infected patients?

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Yes

Unknown

Do you currently treat clients at risk for HIV infection?

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Yes

Unknown

Please contact Joel Peisinger at JPeisinger@mednet.ucla.edu if you would like additional information.

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