Application for Non-credit/Development Course Registration: Summer 2018 Session*Note: This pathway is for individuals pursuing education for personal development, who are not seeking gra
Trang 1Application for Non-credit/Development Course Registration: Summer 2018 Session
*Note: This pathway is for individuals pursuing education for personal development, who are not seeking graduate credit No transcript is generated when registered for
a non-credit Development course (PHPD Masters, Certificate and non-matriculated student are not eligible to register for Non-credit/Development courses.)
Course Name: Interprofessional Team Management of Pain - PREP 244
Course Directors: Alan Witkower, EdD, CGP and Daniel B Carr, MD, FABPM, FFPMANZCA(Hon)
Course Dates: Blended Learning: Onsite, Face-to-Face 2-day weekend at Tufts University School of Medicine, plus 4 synchronous
online videoconferencing sessions
On campus meetings: Sunday, June 3rd at 4 – 7 PM and Monday, June 4th at 9 AM – 5 PM
Online synchronous meetings: videoconferencing for case discussions and team problem-solving continue, on Wednesdays, June 6,
June 13, June 20 and June 27 from 6:00 to 8:00 PM EDT
Successful completion of this course may be able to be applied for professional development/continuing education requirements Contact the course directors in interested in how this course might be used by a participant to meet pain education requirements by the Massachusetts Board of Registration.
Full Name:
Job Title: Organization Name and URL: _ Organization Address:
Home or Mobile Telephone Number: Work Telephone Number: Email: Payment Information:
Registration Fee: On or before May 8, 2018: $947
After May 8, 2018: $757
Please see payment options below:
CHECK: Make checks payable to TRUSTEES OF TUFTS COLLEGE and mail to:
Tufts University School of Medicine, Public Health and Professional Degree Programs Attn: Janice Gilkes, Director of Enrollment Services
136 Harrison Avenue Boston, MA 02111 CREDIT CARD: Please check this box if you plan to pay with a credit card:
You will be contacted by the Tufts University Registrar with further information regarding credit card payment Please make sure you have listed a valid e-mail address above so that we may contact you Thank you.
Completed forms can be mailed to the address above, faxed to 617-636-0898 or sent by e-mail via PDF to
Janice.Gilkes@tufts.edu