UNC Gillings School of Global Public Health

Office of Continuing Education

Introduction to Public Health Nursing (HCE6010114)
September 9-11, 2013

Items marked with an * are required.

*First Name
Middle Name
*Last Name
*Gender Female Male
*Birthdate MM/DD/YYYY
We ask that you provide your birthdate and gender with the understanding that they will be used only as identification for internal record keeping and data processing operations at the University of North Carolina at Chapel Hill.
*Degree ADN
LPN
Diploma
BSN
Others (specify)
No degree
Agency
Type of Agency
*Address (line 1)
Business address if applicable, home address if not.
Address (line 2)
*City
*State
*Zip code
*E-mail Address
Job Title/Position
Occupation
*Daytime Phone Area code + number
Fax
Area code + number
Evening phone Area code + number
*Supervisor's name
*Supervisor's e-mail
*Supervisor's phone Area code + number
How did you hear about this program? Brochure
Calendar
E-mail from the Office of Continuing Education
E-mail from another source
This website
Another website
Colleague
Other (specify):
Are you a student, faculty member, or staff member at UNC-CH?  No  Yes 
Are you a graduate of the UNC-CH School of Public Health? No Yes, department: 
   
  PAYMENT
Registration Fee $70 if paid before August 19, 2013, $90 if paid on or after August 19, 2013
How do you want to pay? Personal check--please send to the address below.
Agency check--please send to the address below.

Make check payable to NCIPH (NC Institute for Public Health) and send to:
Registrar, Office of Continuing Education
Campus Box 8165
UNC-CH School of Public Health
Chapel Hill, NC 27599-8165

Be sure to include with the check:

  • Participant's name
  • Program name
  • Course number

Please note: When you click "Submit Registration" below, you will be taken to a page saying the registration information has been sent. This is NOT a confirmation of your registration. You will receive written confirmation of your registration to the email address provided on your registration form. If you have not received an email confirmation two weeks prior to the program date, call 919-843-9262 or send email to oce@unc.edu to check on the status of your registration.


       
 

If you require any of the auxiliary aids or services identified in the American with Disabilities Act in order to participate in this program, please contact the Office of Continuing Education at 919-843-9262.

Admission to School of Public Health programs is without regard to race, sex, national origin, color, religion, handicap, age or veteran's status.

If you have any questions about this conference or registration, contact Cherelle Whitfield, cwwhitfi@email.unc.edu, 919-843-9262.