Environmental Services A program of the Ontario
Front Line Staff Program | Healthcare Housekeepers’
|Association Inc.
Registration form:
Name _____________________________________________Title___________________________________
Company ______________________________________________________________________________________
Address ___________________________________________________________________________________
City/Province__________________________________________Postal Code__________________________________
Phone # _____________________________________Fax #__________________________________________
E-mail _______________________________________________________________________________________
Please register me in:
[ ] The Course for Front Line Staff
[ ] Please send me more information about the Professional Healthcare Housekeeper Certificate Program
Tuition enclosed:
$100.00 per course (Canadian Funds), payable to the Ontario Healthcare Housekeepers’ Association Inc.
Please do not send cash by mail.
Signature/Date _________________________________________________________
Name ___________________________________ Title____________________________________
Phone # ________________________________ Fax # ____________________________________
E-mail __________________________________________________________________________
Signature/Date :_____________________________________________________________________
Send your completed form, with payment to:
Ontario Health-Care Housekeepers
Assoc.
Professional
Development Courses
2053 County
Road 22
Bath, ON
K0H 1G0
ph
613-352-5696
fax
613-352-5840
secretary@OntarioHealthcareHousekeepers.com