DISASTER TRIAGE TRAIN-THE-TRAINER COURSE Name: Title: Organization: Address: Phone: Email: ___________________________________ Signature Check Session Attending: February 11, 2014 – 9:00 – Noon @ Nicholas Noyes Hospital, Conference Room D REGISTRATION DEADLINE: FEBRUARY 4, 2014 March 18, 2014 – 1:00 – 4:00 @ St. James Mercy Hospital, Memorial Conference Room REGISTRATION DEADLINE: MARCH 11, 2014 March 25, 2014 – 9:00 – Noon @ Unity Hospital, Education Center REGISTRATION DEADLINE: MARCH 18, 2014 INTENDED AUDIENCE: Physicians, Nursing, NP/PAs, EMS, Fire, Police, Pharmacists, Allied Health Professionals, Medical/Nursing Students, Anyone identified to do disaster triage in their agency TO REGISTER EMAIL, FAX or MAIL SIGNED REGISTRATION FORM TO: EILEEN SPEZIO eileen_spezio@urmc.rochester.edu 601 ELMWOOD AVE., BOX 612 ROCHESTER, NY 14642 FAX: 585- 756-5098 PHONE: 585-758-7640 An email confirmation will be sent within three days of receipt of registration. If you have not received confirmation by then, please call Eileen Spezio at contact information above.