CRSN / RRAVCC - CRSN / RRAVCC

CRSN Education Proposal

To suggest an event, workshop, or webinar, please fill out the following form with as much detail as possible.

Requests should be based on current stroke best practice recommendations and should be relevant to our region. Submissions will be reviewed and considered by the CRSN team when planning annual stroke education.

Event Details

Topic or name of event*

Please supply some form of name or title to refer to your proposal with.

Description of Event*

Please enter a description of the event or program

Please provide a short description of the event topic. This may include the location, method of delivery, any guest speakers/ knowledge experts to explore presenting, or any other details you think would help CSRN to make their decision

Reasons for Consideration*

Please enter a description of the event or program

Explain the value of the event for the region and reasons why this request should be supported.

# of Attendees expected

Please enter a description of the event or program

Please estimate the number of people expected to benefit from the event

Estimated cost if any*

Please enter a description of the event or program

Supply an estimated total cost in Canadian currency for the proposed event if known.

Upload files

If you wish, you may upload supporting documents (up to a maximum of 2 mb)

Identification information

Name*

Please fill in your usual or full name

Email Address*

Please supply your email address

^{Enter email of person making program suggestion}

Other Contact information

Please fill in your phone number or email address

Phone number or other contact info to allow us to contact you should we have further questions.

Area of Work within the CRSN*

Coordinator

Best Practice Team member

Educator

Nurse

Allied Health

Manager

Other

Please make one choice

Choose the option that most closely identifies your relationship to the CRSN

Submission of Request

By clicking on the submit button below, your request will be sent to the CRSN for consideration

Click to submit request

CRSN Education Proposal

Please supply some form of name or title to refer to your proposal with.

Please enter a description of the event or program

Please enter a description of the event or program

Please enter a description of the event or program

Please enter a description of the event or program

Please fill in your usual or full name

Please supply your email address

Please fill in your phone number or email address

What's New

Contact Us

Champlain Regional Stroke Network

Phone:

Stroke Prevention Clinic Phone:

CRSN Education Proposal

Please supply some form of name or title to refer to your proposal with.

Please enter a description of the event or program

Please enter a description of the event or program

Please enter a description of the event or program

Please enter a description of the event or program

Please fill in your usual or full name

Please supply your email address

Please fill in your phone number or email address

What's New

Contact Us

Champlain Regional Stroke Network

Phone:

Stroke Prevention Clinic Phone:

Sign in to your account