Bereavement
Training
in pregnancy loss and newborn death
Wednesday, October 21 and
Thursday, October 22, 2009
Medcenter One
College of Nursing
512 N. Seventh St., Bismarck
Deadline for registration is October 5
Sponsored by
Medcenter One Birthcenter One
and Pastoral Care
North Dakota Department of Health
Altru Health System
Registration for RTS
Bereavement training
First name___________________________ MI ____
Last name___________________________________
Place of employment _________________________
Work address________________________________
City________________________________________
State/province _______________________________
ZIP/postal code ______________________________
Work phone ( _____ ) ________________________
Fax ( _____ ) ________________________________
Home address _______________________________
State/province _______________________________
ZIP/postal code ______________________________
Home phone ( _____ ) ________________________
Profession___________________________________
Email address _______________________________
Name for certificates _________________________
(If different from above)
There is a $125 registration fee for all participants.
Registration deadline is October 5.
Please send registration form and payment to:
Attn: Chaplain Burnie Kunz, Pastoral Care
Medcenter One
300 N. Seventh St.
Bismarck, N.D. 58501
Make checks payable to:
To request special facilities or a special diet, please
contact the Medcenter One Pastoral Care
department 701-323-6086.

