Registration Form

Mass Antibiotic Dispensing Workshop
Pre-Registration

An interactive and engaging training experience!

Hosted By: The health department & WV Cities Readiness Initiative

Through a collection of presentations, group activities, and supporting materials, this two-day course will promote ideas, discussion and learning about operating mass medical- countermeasure dispensing sites in a public health emergency.

Intended Audience:

POD managers, staff & partners involved in mass medical countermeasure dispensing

Course Goals:

To provide Point of Dispensing (POD) managers, local and state planners, and POD staff members with skills and tools necessary to effectively and efficiently dispense medications during a public health emergency.

Registrations for the Mass Antibiotic Dispensing Training at the Charleston Civic Center March 9^th and 10^th is full. You are welcome to add you name to a first-come, first served alternate list to be called in case a last minute opening or cancellation would occur. Please include your Name, e-mail and Phone Number below. All openings must be filled by Noon, Monday, March 2^nd!

Attendee Last Name:

Attendee First Name:

Attendee Email address:

Attendee Phone Number: () –Second partThird part

Which Health Deparment are you associated with?:

Are you needing CEU’s?:

For more information contact:

Seth Staker, CRI Coordinator,

Attendee Last Name:
Attendee First Name:
Attendee Email address:
Attendee Phone Number:	() –Second partThird part
Which Health Deparment are you associated with?:
Are you needing CEU’s?: