TRAINING REGISTRATION
Birth Certificate and Electronic Birth Registration System
FAX or Email completed form to Sandy Elledge – 971-673-1202 (sandra.f.elledge@state.or.us) FILL OUT FORM COMPLETELY and return no later than March 10, 2008 Name __________________________________________________________________________________
(First) (M.I.) (Last)
Facility Name ______________________________Street Address__________________________________ Mailing Address (if different) _________________________________________________________________ City _______________________________ County __________________ State _______ Zip _____________ Phone ___________________ Fax _________________ Email ___________________________________ Professional Title:
□ Licensed Midwife □ Registered Midwife □ Lay Midwife □ Registered Nurse □ Medical Doctor □ Birth Clerk □ Other _______________________
I will NOT attend. Please send me information on future webinar demonstrations. I will attend the following Birth Certificate and EBRS training.
Session 1 addresses changes made to the Oregon Birth Certificate and details on how to correctly complete it. Session 2 demonstrates how to use the electronic birth certificate registration system (EBRS) to register a birth. SESSION
(Select a Class or classes from the list below)
Date March 17, 2008 March 17, 2008 March 18, 2008 March 18, 2008
Duration 9 am -12 pm 1 pm – 5 pm 9 am -12 pm 1 pm – 5 pm 9 am -12 pm 1 pm – 5 pm 9 am -12 pm 1 pm – 5 pm 9 am -12 pm 1 pm – 5 pm 9 am -12 pm 1 pm – 5 pm 9 am -12 pm 1 pm – 5 pm 9 am -12 pm 1 pm – 5 pm 9 am -12 pm 1 pm – 5 pm 9 am -12 pm 1 pm – 5 pm
Eugene, Oregon 1 - Birth Certificates 2 - EBRS 1 - Birth Certificates 2 - EBRS Portland, Oregon 1 - Birth Certificates 2 - EBRS 1 - Birth Certificates 2 - EBRS 1 - Birth Certificates 2 - EBRS Bend, Oregon 2 - EBRS 1 - Birth Certificates 2 - EBRS 1 - Birth Certificates Corvallis, Oregon 1 - Birth Certificates
Red Lion Inn | 205 Coburg Road
Portland State Office Bldg. | 800 NE Oregon St. March 27, 2008 March 27, 2008 April 2, 2008 April 2, 2008 May 14, 2008 May 14, 2008 Red Lion Inn | 1415 NE Third St. April 8, 2008 April 8, 2008 April 9, 2008 April 9, 2008 Holiday Inn Express | 781 NE 2 St. April 23, 2008 April 23, 2008 May 20, 2008 May 20, 2008 May 21, 2008 May 21, 2008 Red Lion Inn | 200 N. Riverside Ave.
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2 – Electronic Birth Registration System Medford, Oregon 1 - Birth Certificates 2 - EBRS 1 - Birth Certificates 2 - EBRS