Providing education for today's health care professionals

Register by Mail

For the best print quality, you may want to use the fillable.pdf version of this form. Click HERE to access. Just type in your information on the .pdf form and hit the print button.

Or, print out and mail this registration form with your payment. Checks should be made payable to Regions Hospital.

Mail to: TCHP Education Consortium, Capitol Office Building, 525 Park Street, Suite 120, St. Paul, MN 55103.

Name: ____________________________________________________________

Address: __________________________________________________________

City: ______________________  State: _________________ Zip:_____________

Phone (home): _______________________ Phone (work): ___________________

Organization: ________________________ Job title/Dept.: ___________________

E-mail address:                                                                                                              

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