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
Duration
Eugene, Oregon
Red Lion Inn | 205 Coburg Road
1 - Birth Certificates
March 17, 2008 9 am -12 pm
2 - EBRS
March 17, 2008 1 pm – 5 pm
1 - Birth Certificates
March 18, 2008 9 am -12 pm
2 - EBRS
March 18, 2008 1 pm – 5 pm
Portland, Oregon
Portland State Office Bldg. | 800 NE Oregon St.
1 - Birth Certificates
March 27, 2008 9 am -12 pm
2 - EBRS
March 27, 2008 1 pm – 5 pm
1 - Birth Certificates
April 2, 2008
9 am -12 pm
2 - EBRS
April 2, 2008
1 pm – 5 pm
1 - Birth Certificates
May 14, 2008
9 am -12 pm
2 - EBRS
May 14, 2008
1 pm – 5 pm
Bend, Oregon
Red Lion Inn | 1415 NE