Utah Diabetes Telehealth Program Registration

The University of Utah's Spencer S. Eccles Health Sciences Library, Utah Telehealth Network, and the Utah Diabetes Prevention & Control Program will be broadcasting, recording and archiving the Utah Diabetes Telehealth Series.

Archived presentations will be made available for free at the Utah Telehealth Program Website. Instructions for earning Continuing Education Units for participating in archived programs are posted at the Utah Diabetes Telehealth Archive Website.

All presentations are to be used for educational purposes only and will be protected under the Creative Commons Copyright philosophy. By registering for this program, you are giving permission and acknowledging that the program is going to be recorded, and all remote sites may at some time be recorded during question & answer periods.

A valid e-mail address is required, you will receive an e-mail confirmation once the on-line registration is completed. Please register two days before the live presentation. Instructions and materials for participation will be emailed prior to the presentation.

Fields marked with (*) are required.

*Event Registering for:	Select an Event Date -------------- TeleHealth (General) on February 15, 2012 TeleHealth (General) on March 21, 2012 TeleHealth (General) on April 18, 2012 TeleHealth (General) on May 16, 2012 TeleHealth (General) on June 20, 2012 TeleHealth (General) on July 18, 2012 TeleHealth (General) on August 15, 2012 TeleHealth (General) on September 19, 2012 TeleHealth (General) on October 17, 2012 TeleHealth (General) on November 21, 2012 TeleHealth (General) on December 19, 2012
*First Name:		*Last Name:
*E-mail:		Title:
*Participation Method:
	Telephone
	Web Streaming
	Video Conference
*Site Location:	Select a Site Location ---------------------- Allen Memorial Hospital Bear Lake Community Health Center Bear River Health Department Beaver Valley Hospital Carbon Medical Service Association, Inc. Central City Community Health Center Central Utah Public Health Department Central Valley Hospital Davis County Health Department Desert View Regional Medical Center Eccles Library, University of Utah Green River Medical Center Gunnison Valley Hospital Larry H. Miller Campus - Salt Lake Community College Mountain West Medical Center Mountainlands Community Health Center Salt Lake Valley Health Department, Environmental Health Salt Lake Valley Health Department, Main Office San Juan Hospital Southeastern Utah Health Department Southwest Utah Community Health Center Southwest Utah Health Department Summit County Health Department Sweet Medical Center The Association for Utah Community Health Tooele County Health Department TriCounty Health Department Uintah Basin Medical Center Uintah Basin Medical Center Basin Clinic Utah County Health Department Utah Department of Health Cannon Building Utah Navajo Health System: Blanding Family Practice Utah Navajo Health System: Montezuma Creek CHC Utah Navajo Health System: Monument Valley Health Center Utah Navajo Health System: Navajo Mountain Clinic Wasatch County Health Department Wayne Community Health Center Weber-Morgan Health Department
*Organization:
Address:
City:		State:    Zip:
*Phone:
Fax: