Registration by Invoice

Continuing Education Registration Form

Registration deadline is 5 days prior to the start date.

The information below is critical. All student information, log ins and notices are sent via email only.

Institution Information

* Indicates required field

Hospital/Institution Name *

Hospital/Institution City & State *

Manager's Name *

First

Last

Manager's Email Address *

Attendee Information

Please complete this section if purchasing for all attendees.

Month You Plan to Attend *

Name *

First

Last

Work Email *

Job Title *

Are you a nurse? *

Yes No

Name *

First

Last

Work Email *

Job Title *

Are you a nurse? *

Yes No

Name *

First

Last

Work Email *

Job Title *

Are you a nurse? *

Yes No

Live Events & Conferences

Please choose from the following live events and conferences below to register.

Select One *

Courses

Please choose from the following courses below to register for the selected classes or programs.

Trauma Registrar courses are indicated by (TR) and Trauma Program Manager by (TPM) *

Webinars

Please choose from the following webinars below to register for the selected classes or programs.

Trauma Registrar webinars are indicated by (TR) and Trauma Program Manager by (TPM) *

Submit Your Questions

Submit any questions you have in advance *

Payment & Billing Information

Billing Name / Institution *

First

Last

Billing Phone Number *

Billing Address *

Line 1

Line 2

City

State

Zip Code

Country

Billing Email *

Pomphrey Consulting Training
Program Confidentiality Code

I have registered and paid for the Pomphrey Consulting Trauma Registrar Specific Training Program. As such I am entitled to all course materials. I will not give nor receive unauthorized aid in the completion of this course work, nor distribute any of the course materials.

By typing my full name as my signature, I acknowledge that I have read and agree to the Pomphrey Consulting "Trauma Registrar Specific Training Program Confidentiality Code." *

First

Last

Date *

You must complete the registration process and submit payment by your preferred course's registration deadline in order to secure a spot and ensure receipt of your course materials. You will receive a welcome email within 48 hours of receiving your registration.
Registration is not guaranteed until you have submitted a completed registration form included in the order confirmation email along with paid fees and the minimum number of attendees have registered.
All programs and/or classes have associated continuing education contact hours. A contact hour is sixty minutes of an organized learning activity, which is either didactic or clinical experience.

Submit

Don't just take our word for it.
Our clients have something to say...

“I came in to this hospital and trauma program late in the game after much of the work had already been done by the Pomphrey consulting team. Under Michelle’s guidance, this team was able to diligently work to meet our needs in preparing for Trauma verification survey. I feel that this team’s work is a direct reflection of the success of our trauma verification. Michelle is a consummate professional and she knows the formula to helping other trauma programs succeed. I was impressed with her background and knowledge and felt comfortable putting our delicate program in her hands. I have already recommended her services to my colleagues.

-Jennifer Wobig, RN, BSN, Trauma Program Manager, Cottage Health System, Santa Barbara, CA

Continuing Education Registration Form

Institution Information

Attendee Information

Live Events & Conferences

Courses

Webinars

Submit Your Questions

Payment & Billing Information

Pomphrey Consulting Training
Program Confidentiality Code

Don't just take our word for it.
Our clients have something to say...

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