Register Course Form

​Register Your Course

Instructor First Name *
Date Format	mm/dd/yyyy
Course Date	Course Date Date
Instructor Last Name
Discipline	Doctor Midwife Nurse Birth Attendant Other
Instructor E-mail Address
Address 1
Address 2
City
State
Postal Code
Country Where Facilitator Lives
Telephone
Country Where Course Was Taught	ABKHAZIA AFGHANISTAN AKROTIRI AND DHEKELIA ALAND ALBANIA ALGERIA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA ARGENTINA ARMEDIA ARUBA ASCENSION AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA HERZEGOVINA BOTSWANA BRAZIL BRUNEI BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA, PPLS. REP OF CHINA, REP. OF CHRISTMAS ISLAND COCOS ISLANDS COLOMBIA COMOROS CONGO, DEM. REP. OF CONGO, REP. OF COOK ISLANDS COSTA RICA Côte d’Ivoire CROATIA CUBA CURACAO CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC EAST TIMOR EASTER ISLAND ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA GABON GALAPAGOS ISLANDS GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUATEMALA GUERNSEY GUINEA GUINEA-BISSAU GUYANA HAITI HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISLE OF MAN ISRAEL ITALY JAMAICA JAPAN JERSEY JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, DEM. PPLS. REP. OF KOREA, REP. OF KOSOVO KUWAIT KYRGYZSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUUANIA LUXEMBOURG MACAU MACEDONIA MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARQUESAS ISLANDS MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA MOLDOVA MONACO MONGOLIA MONTENEGRO MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAGORNO KARABAKH NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN CYPRUS NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PEOPLE'S REP. OF CONGO PERU PHILIPPINES PITCAIRN ISLANDS POLAND PORTUGAL PRIDNESTROVIE QATAR REUNION ROMANIA RUSSIA RWANDA SAINT HELENDA SAINT KITTS AND NEVIS SAINT LUCIA SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOMALILAND SOUTH AFRICA SOUTH OSSETIA SPAIN SRI LANKA SUDAN SURINAME SVALBARD SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN WAJIKISTAN TANZANIA TAJIKISTAN THAILAND TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TRISTAN DA CUNHA TUAMOTUS TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES URUGUAY UZBEKISTAN VANUATU VATICAN VENEZUELA VIETNAM VIRGIN ISLANDS, BRITISH WALLIS AND FUTUNA WESTERN SAHARA YEMEN ZAMBIA ZIMBABWE
Language
Lessons Learned *
Teaching Method	Classroom Team Pair
Course Conducted	HBB ECEB ECSB
Doctor - Total Number Taught by Discipline
Nurse - Total Number Taught by Discipline
Midwife - Total Number Taught by Discipline
Birth Attendant - Total Number Taught by Discipline
Other - Total Number Taught by Discipline
Doctor - Knowledge Check Number Passed
Nurse - Knowledge Check Number Passed
Midwife - Knowledge Check Number Passed
Birth Attendant - Knowledge Check Number Passed
Other - Knowledge Check Number Passed
Doctor - Bag Mask Skill Number Passed
Nurse - Bag Mask Skill Number Passed
Midwife - Bag Mask Skill Number Passed
Birth Attendant - Bag Mask Skill Number Passed
Other - Bag Mask Skill Number Passed
Doctor - OSCE Station A Number Passed
Nurse - OSCE Station A Number Passed
Midwife - OSCE Station A Number Passed
Birth Attendant - OSCE Station A Number Passed
Other - OSCE Station A Number Passed
Doctor - OSCE Station B Number Passed
Nurse - OSCE Station B Number Passed
Midwife - OSCE Station B Number Passed
Birth Attendant - OSCE Station B Number Passed
Other - OSCE Station B Number Passed
Details	Type the Web address: (Click here to test)   Type the description:
Captcha	BotDetect CAPTCHA Feature for SharePoint