Violence Prevention Course Registration Form

Breaking the Cycle

A Day-Long Conference for Students and Providers

(UCSF Course: Epi 180.08 Violence Prevention: Causes, Effects, Solutions)

 A one day conference addressing violence, its impact on individuals and society, and what YOU can do about it.

When: Saturday, January 6, 2007, 8:00 a.m. to 6:30 p.m.

 Where: Nursing Lecture Hall Lobby (registration); N-225 and S-Building classrooms (sessions), UCSF, Parnassus Campus

What: Topics include: The Psychological Effects of DV on Children and how to Reverse the Damage; How Kaiser Permanente's DV Prevention Program was implemented; Cultural Issues in Domestic Violence; Work with the Male Population; A Health-Care Provider Panel on DV Screening techniques workshops for Medical, Nursing, Physical Therapy. Dental and Pharmacy Personnel; A Survivor's Panel, and much, much more!

Who: The conference is geared towards future and current healthcare providers in Medicine, Nursing, Pharmacy, Physical Therapy and Dentistry, but anyone who is interested in learning more about domestic violence can attend!

 Credit: UCSF students can receive one unit of credit for attending the conference. Register for Epidemiology 180.08 and sign the various attendance sheets during the day.

 Registration Fee: $13.00 (includes breakfast, lunch, snacks, pocket-sized clinical resource guide, community reference list, and other printed material.)

 Method of Payment: $13 check made out to SHPSR

(Student Health Professionals for Social Responsibility)

Send check to: 
            SHPSR Violence Prevention Conference
            Attn: Michelle
            Office of Student Affairs
            513 Parnassus Ave, Room S-245
            San Francisco, CA 94143-0454

Checks must be received by Wednesday, January 3, 2007.     

 

Please fill in the following information to register for the full day course. You will receive an email confirming your registration.

Name:
Address:
City:
State:
Zip:
School and Year:
Phone:  
Campus Mail Box:  
E-Mail:
Affiliation (if not  UCSF Student):  

$13.00 check: date sent:

How did you find out about this conference? (check all that apply)

Identify one thing you would like to learn by attending this conference.