Telehealth Registration

Asthma Telehealth (a continuing education program for health professionals). Registration

All presentations are to be used for educational purposes only and will be protected under the Creative Commons Copyright philosophy. By registering for this program, you are giving permission and acknowledging that the program is going to be recorded, and all remote sites may at some time be recorded during question & answer periods.

A valid e-mail address is required, you will receive an e-mail confirmation once the on-line registration is completed.

Program materials, phone number and/or webstreaming link will be sent to you the day before the presentation.

• Asthma Telehealth Program Information

Fields marked with (*) are required.

*Event Registering for:	Select an Event Date -------------- TeleHealth (General) on August 06, 2013 TeleHealth (General) on November 05, 2013
*First Name:		*Last Name:
*E-mail:		Title:
*Participation Method:
	Telephone
	Web Streaming
	Video Conference
*Site Location:	Select a Site Location ---------------------- Allen Memorial Hospital Bear Lake Community Health Center Bear River Health Department Beaver Valley Hospital Carbon Medical Service Association, Inc. Central City Community Health Center Central Utah Public Health Department Central Valley Hospital Davis County Health Department Desert View Regional Medical Center Eccles Library, University of Utah Green River Medical Center Gunnison Valley Hospital Larry H. Miller Campus - Salt Lake Community College Mountain West Medical Center Mountainlands Community Health Center Salt Lake Valley Health Department, Environmental Health Salt Lake Valley Health Department, Main Office San Juan Hospital Southeastern Utah Health Department Southwest Utah Community Health Center Southwest Utah Health Department Summit County Health Department The Association for Utah Community Health Tooele County Health Department TriCounty Health Department Uintah Basin Medical Center Uintah Basin Medical Center Basin Clinic Utah County Health Department Utah Department of Health Cannon Building Utah Navajo Health System: Blanding Family Practice Utah Navajo Health System: Montezuma Creek CHC Utah Navajo Health System: Monument Valley Health Center Utah Navajo Health System: Navajo Mountain Clinic Wasatch County Health Department Wayne Community Health Center Weber-Morgan Health Department
*Organization:
Address:
City:		State:    Zip:
*Phone:
Fax: