Education Session Request
Education Details:
Which session/s would you like conducted?
The Skin, Wound Healing and Skin Tears
Pressure Injuries and IAD
Lower Leg Wounds
Wound Assessment and Management
Stoma Fundamentals
Healthy Skin: Carer's Session
Preferred Date
-
Month
-
Day
Year
Date
Preferred Time?
Hour Minutes
AM
PM
AM/PM Option
Audience
Please advise if the education session is being delivered to Registered Nurses, Enrolled Nurses, Allied Health Staff, Medical Practitioners and/or students?
Number of Attendee's?
Location Information
Facility Name:
Name of Contact
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parking Availability (and special instructions)
Administration
Will Wound Innovations be supplying evaluation forms or does the service have their own?
WI to supply
Service has own
Will a local senior staff member be present on the day to coordinate staff?
Yes
No
If yes - what is their name?
Presentation
Is there a large TVscreen/projector available and does it work?
Yes
No
Is there a HDMI cable attached with adequate length to setup a laptop?
Yes
No
Is there a nearby power supply?
Yes
No
Full day education events
Have arrangements for lunch been made or are attendees providing their own?
Attendees providing their own
Service to arrange
Submit
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