RAIN Community Technology Campus





Telemedicine Workshop Signup



Let us know your background:
Please select one:
Clinic
School Health
County Health
Private Practice
Nurse

Other





Name :

Agency Name(up to 35 ):

Address :

City / State / Zip :

Phone

Fax

Email

Web Site Address



I will be attending:
Friday November 2, 2001

Saturday November 3, 2001 - 9 a.m. - 1 p.m.

Friday & Saturday



If you prefer you may:
Fax to: 805-899-8698

Or:
Mail to:
RAIN Network - Telemed
1129 State Street A7
Santa Barbara, CA
93101