Sexual Assault Nurse Examiner Training  

 

September 8 - 12, 2010

8:00 AM – 5:00 PM  

MONA Approval Number 710-VIII-22

North Kansas City Hospital Health Services Pavilion

Prairie View Teleconference Room

2790 Clay Edwards Drive

North Kansas City , Missouri 64116  

¯36.5 hours CEU (applied & previously approved) for this SANE Training,

    14 which have been approved for trauma hours. 

    ¯Course fee (includes lunch all 5 days) is $ 375.00 and must accompany registration to hold your place.

    ¯Once your registration is processed, you will receive a letter of confirmation with directions and details so please be sure to list your home address or an appropriate address on the registration form so you will receive this information in a timely manner.

    ¯Deadline for registration is August 31, 2010 . Payment must be received by that date. If unsure that mail will arrive by that date, please call Carolyn Cordle, RN, SANE and credit card information may be processed over the phone to secure your spot. (Sorry, no refunds after February 26, 2010.)   If you cancel after deadline, your fee can only be applied to the September 2010 SANE Training course less $75 cancellation fee.

    ¯Class Minimum is 8 attendees, Maximum is 20 attendees.

    ¯ For more information, contact Carolyn Cordle, RN, BSN, SANE-A at:

    Please PRINT out this information, keep this page for your records & MAIL or FAX the following Registration Form with payment.

     .  mail your registration to:           or         BU08.gif 1.3K  FAX to our secure fax line:  

      COVERSA                                                                 816-221-2189                          

                                            ATTN:  SANE Training

                                    2900 Clay Edwards Dr. Ste #205

                                           North Kansas City , Missouri 64116  

    Ä Your confirmation/registration information for the September SANE Training will be mailed to you.  If you have NOT received any correspondence within 2 weeks of submitting your registration, please notify us.

    J Thank you!


    September 8 - 12, 2010 SANE Training

    COVERSA Registration Form 

     Name:_________________________________________________________________ □ RN

     Home) Street Address:____________________________________________________________

     City:_______________________________________State:__________  Zip:________________

     Home Phone:_________________________Alternate Phone:_____________________________

     Email Address:__________________________________________________________________

    Affiliation/Employer:_____________________________________________________________________

     Please tell us how you heard about this SANE Training course:

q     COVERSA website

q     Web search

q     Word of mouth from _____________________________________________________

     q     Employer

q     Other: _______________________________________

$ 375 PAYMENT INFORMATION:

(Full payment must accompany registration to hold your place)

q Check or Money Order payable to COVERSA

q COVERS now accepts PayPal (If you use Paypal please fax copy of registration to 816-221-2189 or call Carolyn 816-691-5441.

.  mail this registration to:                              or                            BU08.gif 1.3K FAX to: 

                                         COVERSA                                                                                    816-221-2189

ATTN:  SANE Training

2900 Clay Edwards Dr. Ste 205

North Kansas City , Missouri 64116

Ä  Your confirmation/registration information for the March SANE Training will be mailed to you.  If you have NOT received any correspondence within 2 weeks of submitting your registration, please notify us.

J Thank you!