Corrections Connections:

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Presentation transcript:

Corrections Connections: Forming Partnerships to Stop TB Registration Form For your convenience, Corrections Connections is being held on three dates. Please check the date you wish to attend: Thursday, April 26, 2007  Friday, April 27, 2007  Friday, May 11, 2007 Last name__________________________ First__________________________ Credentials (MD, RN, etc.)__________________________________________ Facility__________________________________________________________ Address__________________________________________________________ __________________________________________________________ Daytime phone____________________________________________________ Email____________________________________________________________ Continuing Education Credit Requested:  Continuing Medical Education  Continuing Nursing Education Please mail or fax this registration form by Friday, April 13, 2007 to: Denise Lancto Division of TB Prevention & Control 305 South Street Jamaica Plain, MA 02130 Fax: (617) 983-6990 Presented by: MA Department of Public Health Bureau of Communicable Disease Division of TB Prevention & Control • MA Department of Correction • County Correctional Healthcare Administrators Group • UMass Correctional Health Program. Centers for Disease Control and Prevention • Northeast Regional Training and Medical Consultation Consortium