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Telemedicine Courses Online Registration

Three-Day Telemedicine Course, August 13-15, 2008 at Sacramento, CA
Or, part of the course:
Day 1, Executive Overview, August 13, 2008
Days 2 and 3 Tech/Clinical Ops (August 14 & 15, 2008)
Name   *First      *Last    
Degree/Suffix M.D.  Ph.D.  R.N.  L.V.N.   P.A.  other 
Job Title  
Organization
*Mailing Address
*City
*State *Zip Code
Phone Fax
*E-Mail Address
*Social Security Number (last 4 digits only)
*Fee and Scholarship Information
California based organizations with not-for-profit status  - $300 per person for a one-day session; $1,000 per person for three-day session;
California based organizations with for-profit status - $500 per person for a one-day session; $1,500 per person for three-day session;
Organizations based outside of California - $500 per person for a one-day session; $1,500 per person for three-day session
Check here if pursuing a fee waiver from the Center for Health and Technology. Fees may be waived for organizations meeting the criteria listed below. Please send your written documentation addressing each criterion to Janice Carpenter.
1. Organization provides at least 75 percent of care to underserved or indigent populations;
2. Organization has a limited operating budget;
3. Organization is community-based with strong, local input;
4. Rural Provider;
5. Located in California.
Payment Information
— Please make your check payable to UC Regents and send it to Janice Carpenter.
— Credit Cards: We accept Visa, MasterCard, Discover, AMEX. Please phone Janice at (916) 734-1314 with your credit card details.
Further Information
— If you need disability accommodations, please let us know:  
— If you have dietary requirements, please list details: