EMBS COURSE REGISTRATION

Fill out the form below.
For enquires, please contact Mrs Susan Parkes: 083 536 6806

EMSB Courses Registration
TITLE *
GENDER *

QUALIFICATIONS

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WORK / HOSPITAL PHYSICAL ADDRESS
WORK / HOSPITAL PHYSICAL ADDRESS
City
State/Province
Zip/Postal
Country
HOME ADDRESS (POSTAL)
HOME ADDRESS (POSTAL)
City
State/Province
Zip/Postal
Country
DIETARY PREFERENCES *

PRE-COURSE READING MATERIAL

• Course Material will be emailed to you at least 2 weeks prior to the training event.
• Please make sure that you study the material BEFORE the training day.
TRAINING DAY:
• The training day consists of:
- Lectures
- Skills Stations
- Discussion Groups
- Multiple Choice Exam
- Clinical Exam
PRINTED MANUAL *
Would you like a printed hard copy to be available for you on the training day?
HOW DID YOU HEAR ABOUT THE COURSE? *

COURSE FEE

1 DAY COURSE - Rxxx,xx
2 DAY COURSE - Rxxxx,xx

BANKING DETAILS:
SA Burn Society
First National Bank
Account number: 62434454708
Code: 2506558

UPLOAD PROOF OF PAYMENT *

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