REGISTRATION DEADLINE – APRIL 17TH
$50 LATE FEE APPLIES FOR APPLICATIONS RECEIVED AFTER THIS DATE
Please note that with the new 1-day course format, the online portion of the course MUST be completed prior to attending the LIVE portion of the course. Please allow sufficient time to complete the online modules.
Complete the form and return by email, fax or mail to:
Crystal Caven, ALSO Course Coordinator
Santa Rosa Family Medicine Residency
3569 Round Barn Circle, Suite 200
Santa Rosa, CA 95401
Fax: (707) 583-8808
Questions? Email Crystal at CavenC@sutterhealth.org
Payment must be received by April 17, 2020.
Checks must be made payable to: Sutter Santa Rosa Regional Hospital. Can be delivered in person or mailed with registration form.
Credit Card Payments: Complete the card information on the registration form and mail or fax to course coordinator (email not secure)