Intent to Host Form

If you are interested in bringing the Academy of Medical-Surgical Nurses (AMSN) Certification Review Course to your facility, complete this form and we will contact you.

Please list your first choice for the begin date you would like to host the course. The course must be held 2 days in a row. We can accommodate weekends.
Please list your second choice for the begin date you would like to host the course.
Please list your third choice for the begin date you would like to host the course.
Please leave any additional questions/comments for us.