Dementia Generalist for Healthcare Providers

Online Refund Policy: There are no refunds or cancellations for this training. The Dementia online training is available to registrants for 6 months.

If you have any questions, call (920) 424-1071 or email regstaff@uwosh.edu

Fields with asterisk are required.

Participant First Name *
Middle Initial (or NA if none) *
Participant Last Name *
Date of Birth (MM/DD/YYYY) *
Agency Name *
Agency Type *
If agency type is other please enter here
Nursing Home License #
Agency Address *
Agency City *
Agency State *
Agency Zip Code *
Agency County *
Position Title *
Daytime Phone Number - Use the format (000-000-0000) *
Participant Email Address (for registration confirmations) *
Supervisor Full Name
Supervisor Email

$45.00

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