Curso Taller Ficha Inscripcion

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CURSO TALLER “ACERCANDO LA SALUD SEXUAL AL EQUIPO DE ATENCION PRIMARIA” FICHA DE INSCRIPCION APELLIDOS: ________________________NOMBRE:__________________________ RUN: _______________-__

CENTRO DE SALUD:__________________

PROFESION: _____________________

CARGO: ___________________________

EMAIL: ___________________________________ CELULAR: _______________________

FORMACION ANTERIOR EN EL TEMA:

NOMBRE DE LA CAPACITACIÓN/ AÑO / NIVEL: _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

Remitir inscripciones hasta el 17 de Abril a Sr. Johnny Acevedo a:

[email protected]>

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