School Nurse Orientation Registration

Cross Office Building, Augusta, Room 103 A and B

First Name:	Last Name:
Phone Number:	Cell Phone Number:
Email Address:	Name of Nurse Replacing:
School(s) Covered:	School Administrative Unit:
Years as a School Nurse:	MASN Member Yes No
I will attend all 3 New School Nurse Orientations * September 28, 2012 * November 9, 2012 * March 22, 2013 (All three days are required to complete orientation)

Contact Hours will be provided for the day.

There is no registration fee, but lunch will be on your own.