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MCMI 2021 Training - Level 1 and Level 2 Registration Form
Date of Training: June 18th, 2021
Location of Training: Zoom
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Last Name
*
Your answer
First Name
*
Your answer
Email Address
*
Registration Confirmation and Zoom Link will be sent to this email.
Your answer
Cell Phone Number
*
Your answer
Affiliation
*
Name of school or healthcare practice.
Your answer
Title/Profession
*
Athletic Trainer
School Nurse
Athletic Director/Athletic Administrator
Physician
Physician Assistant
Nurse Practitioner
Physical Therapist
Student- PT
Occupational Therapist
Student-OT
Speech Therapist
Student- SLP
Parent
Other:
Which level(s) will you be attending?
*
Please select the level(s) you will be attending. Highly suggested that Level 1 is attended prior to attending Level 2.
Level 1 - An Introduction to Concussions and Concussion Management
Level 2 - Advanced Concussion Management (Prerequisite: Level 1 Training)
Required
If You Need More Information:
For details regarding the presentation please contact Jan Salis at
jsalis@aol.com
or 207-577-2018.
For issues/questions regarding registration please contact Haley Driscoll at
hdriscoll1@une.edu
or 603-860-2468.
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