Trauma Talks RegistrationPlease fill out the registration form below. Upon submittal, you’ll be directed to our secured payment site. First name Last name Address Name of Employer Best E-mail Address for correspondence Professional License # This field is mandatory if receiving CMU/CEU's - Continuing Education Credits Halifax Health Employee ID # If Halifax Health Employee please provide the entire 9 digits of your 500 # Will you be paying by employee deduction? ---No, I am not an employee or do not plan to use employee deduct.Yes, I plan to use employee deduct, and I do authorize the deduction. Please choose a t-shirt size ---XSmallSmallMediumLargeXLargeXXLargeXXXLarge
