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Continuing Education Registration Form

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

Attendee / Institution Information

* Indicates required field

Name *

First

Last

Credentials *

Position *

Hospital/Institution Name *

Hospital/Institution City & State *

City, State

Registration Level: *

I am registering on behalf of staff only and should not be included as a participant Individual registration - If multiple students are listed, I am included as a participant

Work Email Address *

Phone Number *

Manager's Name *

First

Last

Manager's Email Address *

Are you a nurse? *

Yes No

Distance Learning Programs
(new classes begin monthly)

Deadline for registration is the 15th of the month PRIOR to program/class start.

Trauma Registrar Mentorship Monthly Program:

$975 (includes the Trauma Registrar Specific ICD-10-CM Training)

For calendar, dates & times, please click here

Trauma Registrar Specific ICD-10-CM Training:

$500 (with Anatomy)

Lectures are recorded with a live question and answer session each week. Recordings are accessible during specific designated times only, and will begin the first Monday of each month.

For calendar, dates & times, please click here

Preceptor:

Cost determined on individual hospital requirement

TARP:

$500

For calendar, dates & times, please click here

Trauma Program Manager Mentorship Program:

$1,000 (includes Trauma Registrar Specific ICD-10-CM Training)

For calendar, dates & times, please click here

Trauma Registrar Courses

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

Choose from the following Trauma Registrar Courses *

Preceptor | Price determined on individual hospital requirements Trauma Registrar Specific ICD-10 Training Program | $500 TARP (Trauma Advanced Registrar Prep) | $500 Trauma Registrar Mentorship Program | $975

Trauma Registrar Webinars

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

Choose from the following Trauma Registrar Webinars *

Please note the month you plan to attend. *

Additional Attendee Registration *

If you are a manager and are registering multiple people, please list their full name and employee email below.

Trauma Program Manager Courses

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

Choose from the following Trauma Program Manager Courses *

Trauma Program Manager | $1,000

Trauma Program Manager Webinars

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

Choose from the following Trauma Program Manager Webinars *

Please note the month you plan to attend. *

Additional Attendee Registration *

If you are a manager and are registering multiple people, please list their full name and employee email below.

On-Site Live Classes

Please fill in the course details below to register for the selected live classes.

Course Title *

Cost *

Additional Attendee Registration *

If you are a manager and are registering multiple people, please list their full name and employee email below.

Classes

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

Choose from the following courses *

Please note the month you plan to attend. *

Additional Attendee Registration *

If you are a manager and are registering multiple people, please list their full name and employee email below.

Payment & Billing Information

CHECK made payable to Pomphrey Consulting. Please note student's
name and mail to 2683 Spring Hill Road Staunton, VA 24401

Name / Institution *

First

Last

Billing Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Billing contact phone number

Email *

Billing contact email address

Type full name as your signature *

First

Last

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.

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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

Pomphrey Consulting: assisting trauma hospitals in the US with data abstraction, data validation, program evaluation, state trauma registry development, and training.

Comprehensive Trauma Program

CONTACT

Phone

540-448-2770

General Information

info@pomphreyconsulting.com

Education Information

education@pomphreyconsulting.com

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