DISTANCE TRAINING PHARMACOLOgy

DISTANCE TRAINING
PHARMACOLOGy
REGISTRATION FORM
PERSONAL INFORMATION
Family nameFirst name
Licende no.Address
City
Postal code
Telephone (home)Email
course Title
Prix
Training PROGRAM — PHARMACOLOGy
45 hours
125,00 $
Please return this form with your payment
(cheque or money order) to the following address:
Ordre des infirmières et infirmiers auxiliaires du Québec
c/o Nicole Bélanger
531, Sherbrooke St. East, Montreal (Quebec) H2L 1K2
Fax : 514 282-0693
Crédit card : Visa Mastercard
Card no.
Expiry date
Signature
COURSE FEES ARE NOT REFUNDABLE
Programme
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formation
continue 2010
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2011 Continuing
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