training by correspondence pharmacology
Transcription
training by correspondence pharmacology
TRAINING BY CORRESPONDENCE PHARMACOLOGY REGISTRATION FORM PERSONAL INFORMATION Family name First name License no. Address City Postal code Telephone (home) Email COURSE TITLE PRIX TRAINING PROGRAM — PHARMACOLOGY MEMBERS: $150.00 45 HOURS ON 90 DAYS Please return this form with your payment (cheque or money order) to the following address: Ordre des infirmières et infirmiers auxiliaires du Québec 531, Sherbrooke St. East, Montreal (Quebec) H2L 1K2 Crédit card : Visa Mastercard Card no. Expiry date Signature COURSE FEES ARE NOT REFUNDABLE PROGRAMME DE FORMATION CONTINUE 2010 | 2011 CONTINUING E D U C AT I O N PROGRAM 1