Please print or type CLEARLY: Name: ________________________

1. This course will be conducted at Texas Children’s Hospital – Clinical Training and Development Center – 2nd floor Meyer Bldg 1919 South Braeswood Houston Texas 77030 Deadline: Course limited to 24 people – RNs will receive verification card – RTs, EMTs, and LVNs may audit the course. Cancellations accepted up until March 15, 2009. A $25 non-refundable administrative cost will be forfeited and $35 for the cost of the book Mail to: Cynthia Kay Jenkins 6621 Fannin MC 1- 1480 Houston Texas 77030 832-824-5968 (office) 832-825-5439 (fax) Make Checks payable to: Texas Children’s Hospital Cost: $100.00 TCH/IDS employees $ 250.00 non TCH/IDS employees Please print or type CLEARLY: Name: ________________________ Address: _____________________________ _____________________________ Phone: ______________________________ Employer and Department: _____________________________ Email Address: _____________________________ Course Director: Cynthia Jenkins ckjenkin@texaschildrenshospital.org Emergency Nursing Pediatric Course (ENPC) Provider CourseTexas Children’s HospitalMarch 31 – April 1, 2009 15.3 contact hours In accordance with the Americans with Disabilities Act, please advise Cynthia Jenkins if you have any disability that requires special materials and/or services so that appropriate personnel can be advised. The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation