Registration Form Foot Care Forum 2021

Foot Care Forum Whakatu October 2021 Application for Registration

Foot Care Forum for Registered Nurses Saturday 30th October 2021

Venue: Nelson Tasman Hospice, 331 Suffolk Road Stoke, Nelson

8:30am Registration 9am - 5pm Foot Care Forum

Guest Speakers Heather Woods NZRN Foot Care Nurse Specialist Lyn Harris NZRN Foot Care Nurse/Specialist Nurse Amputee Care Charlotte Russell – Podiatrist/The Shoe Room Claire O’ Shea - Waikato DHB Lead Podiatrist Space is limited to 75 attendees $120 per person Lunch provided To secure your place send your registration to: Te Piki Oranga Whakatū E admin.whakatu@tpo.org.nz P +64 3 546 9099

Registrations Close 23rd October 2021

Applicant Details

FOOT CARE FORUM WHAKATŪ 30th October 2021

Name Full Address

Phone Email Organisation Current Qualifications Ethnicity How did you hear about this Forum Are you interested in future forums/training

Yes

No

Would be interested in being part of an ongoing group for further development

Yes

No

Any Dietary Requirements Application Fee of $120

Te Piki Oranga Internet banking number TBA on your registration

For more information you can contact any of the committee

Heather Woods NZRN Christchurch hjwoods@gmail.com 0212889618 Karen Davidson NZRN Whakatu Nelson karen.davidson@tpo.org.nz 0278017751 Dianne MacDonald NZRN Whakatu Nelson dianne.macdonald@tpo.org.nz 0274725100 Lyn Harris NZRN Waikato feetretreat4u@gmail.com 0212587007

Signed : ________________________________________ Date: _______________

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