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Conference Registration for June 14th Training-Colby College, Waterville, ME

Tentative schedule:

7:30am- 8:00am: Registration and Continental Breakfast

8;00am-8:30am: Introduction and Overview

8:30am-12:00pm: MCMI Training (Level 1 and 2 to be run simultaneously)

o Level 1- An Introduction to Concussions and Concussion Management

o Level 2- Interpreting Neurocognitive Testing (Please note-participants should complete Level 1 training before completing Level 2)

Registration Fee:

$100 for health care providers.

$40 for all other attendees.

Registration Fee includes conference attendance and continental breakfast.

Preferred Email Address:

Registration confirmation will be sent to this email.

Full Name:

Address Line 1:

Address Line 2:

City:

State/Province:

Enter your state/province if applicable

Zip:

Phone #:

Enter your phone number (in case we need to contact you)

Affiliation:

Please enter the school or medical practice you are affiliated with.

Title/Role:

Please enter your title/role at your school or practice (school nurse, athletic director, team physician, athletic trainer, etc.)

CEU/CME credit:

yes

Please indicate if you are taking this course for continuing education credit. If you are taking this course for credit, the registration fee is $100. If you are NOT taking this course for credit, the registration fee is $40.

Level you plan on attending:

Level 1- An Introduction to Concussions and Concussion Management

Level 2- Interpreting Neurocognitive Testing (Please note-this is only for those that have previously attended a MCMI Level 1 training!)

Please indicate which level you wish to attend.

Comments:

Goldfarb Center

Maine Concussion Management

MCMI Use Only

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