Registration

April 18, 2014

Disclosure: The How and When of Communicating About Unexpected Outcomes and Errors

NOTE: This Registration Form is for participants who are not associated with Vanderbilt or CPPA, or are not from institutions using PARS. Use the Online Registration sidebar link or your browser back button to see alternative registration forms. Questions? Contact us.

Registration fee is $200 per participant. Registration fee includes all sessions, course syllabus, and all food functions. Suggested attire is business casual. A registration confirmation will be sent to the email address you provide.

The afternoon Train the Trainer session is optional. See the Course Brochure for more information.

Required form fields are highlighted in yellow.

If you will be staying for the optional afternoon Train the Trainer session, please check this box.

If your mailing address is a non-US address, please check this box before filling in your address information below.

Payment

Registration and payment must be received by April 11, 2014. Checks may be made payable to: The Center for Patient and Professional Advocacy.

To pay by credit card: download this credit card payment form and return the completed form to CPPA.

Please submit payment to:

The Center for Patient and Professional Advocacy
Vanderbilt University Medical Center
ATTN: Disclosure Course
2135 Blakemore Avenue
Nashville, TN 37212-3505
Phone: 615.343.4500 • Fax: 615.343.8580