HEARTT Symposium 2012

1. Will you be attending the HEARTT Pre-Departure Workshops in Evanston, Illinois?

Will you be attending the HEARTT Pre-Departure Workshops in Evanston, Illinois? Yes, the entire conference: Friday and Saturday July 13-14, 2012.

Yes, only Friday July 13, 2012.

Yes, only Saturday July 14, 2012.

No.

2. If faculty, will you be attending the HEARTT faculty meeting on Friday, July 13 at 5 p.m.?

If faculty, will you be attending the HEARTT faculty meeting on Friday, July 13 at 5 p.m.? Yes.

No.

3. Registration:

Registration: Name:
Institution:
Title: (faculty, resident, administrator)
Specialty: (Emergency, Pediatric, Mental Health, Surgery, Women's Health, Admin)

4. Do you have any dietary restrictions or allergies?

Do you have any dietary restrictions or allergies?

5. Your email address for HEARTT 2012 updates.

Your email address for HEARTT 2012 updates. Email Address: