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This event is an Accredited Group Learning Activity (Section 1) with one hour credit per hour of instruction, as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada.
Please complete the following form and submit it.
Then register your credits with the Royal College of Physicians and Surgeons. You will receive your proof of participation by mail.

Name:
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Mailing address:
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Workshop date:
to:

Location:

Hours of Instruction:

On a scale of 4, how do you rate the following:

	Strongly Disagree	Disagree	Agree	Strongly Agree
Book clearly and logically organized.
Workshop objectives relevant to my learning needs.
The workshop and book met my educational objectives and expectations.
The workshop and book content matched the objectives listed in chapter of the book.
The primary survey and sequences are clinically useful.
The sequences are easy to follow.
The case studies are helpful to illustrate step by step management.
Overall, this workshop is a useful review of the acute care of newborns.

What was good about the book and workshop?

How could the workshop or book be improved?

How might you use this information in your practice?

Additional suggestions / comments: