Education Courses Registration of Interest Form

Name
Practice/ *Hospital (must be in SA to register)
Address:
Phone/Fax
Email
Are you a Registrar, Resident Rural Doctor or Nurse Registrar
Rural Doctor
Nurse
Which course/courses would you like to attend?
Have you attended an Emergency Medicine Program in the past 12 months
If yes, please specify:
    
Note:
*Hospital - for Registered Nurses who are registering their interest for Rural Emergency Skills Program (RESP)
*Registered Nurses can only apply for Rural Emergency Skills Program (RESP)

Completion of this form does not guarantee a place on the course