COEC Teacher Workshop Application Page

Application for the Cell Biology Workshop @ MIT

Workshop dates: Tuesday January 12 and Wednesesday January 13, 2010.
(Forms do not automatically clear after submission.)

Basic Information:

First Name Last Name
Nursing License #
Home Address
City State Zip
Home Phone
E-mail Address (Home/Personal)

Name of Institution
Institution Address
City State Zip
Work Phone
Work E-mail Address

Clinical Area: Pediatric Adult Both

Specialty

Basic Nursing Education

Highest Level Nursing Education

Additional Questions:

MIT has parking available by permit only in its visitor parking lot. Will you need parking permits?
The workshop is taking place at the MIT Museum (265 Massachusetts Ave., Cambridge, MA), easily accessible via the Red Line (Central Square exit) or the #1 Bus.

We have sessions planned at different sites on campus. Please indicate if you have any mobility issues that we should be aware of.

How did you hear about this workshop?

when done, or if you want to start over.