College of Nursing & Professional Disciplines

Training Registration

Field Instructor Training Registration

Please use this form to register for the Field Instructor Training being held on Friday, April 3, 2020, at the Evan L Lips Auditorium (located in the Altru Family Medicine Residency Building next to the UND Bookstore).

First Name*

Last Name*

Phone*

Email*

Mailing Address*

City*

State*

Zip Code*

Live Stream Only

If you are registering for live stream only, please use the URL below:
https://und.zoom.us/j/790619168

License#

License State

Agency (if applicable)

Are you a Field Instructor?

Do you need a certificate of attendance to claim CEUs for this session?

LUNCHEON INFORMATION

Are you planning to attend the luncheon?

Special Dietary Needs

Please indicate above if you require special dietary accommodcations (e.g., vegan, vegetarian, gluten free, etc)