Oregon Burn Center Workshop Registration

Please complete this form to finalize your registration for our workshop with Oregon Burn Center. After submitting, you will receive a confirmation email with additional information, including the Zoom link for the workshop.

Name*
First Last
Email*
Phone*
Mailing Address*
Street Address City State ZIP Code
Workshop:*
Would you like us to mail you a journal?*
We provide each of our participants with a new journal as part of our workshops. Please confirm that you'd like a journal and we'll send it to the address listed above.
- Yes, please mail me a journal
- No thanks, I'll use a journal I already have.
Journal Preferences:
Please note any preferences you have for your journal (lined or unlined pages, larger or smaller size, etc). While we are limited to journals that have been donated to our office, we'll do our best to send you one you'll like!
Do you have any questions or concerns, or anything you would like to share with us? Is there anything that will allow you to more fully participate in this workshop? If so, we'll follow up with you before the first session.