Daytona Area FL COPD Coalition Community Workshop 1. COPD Workshop- Daytona Beach, FL- March 24th and 25th, 2011 Question Title Hilton Oceanfront Hotel100 North Atlantic AvenueDaytona Beach, FL32118 Question Title * 1. Name Question Title * 2. Credentials Question Title * 3. Organization Question Title * 4. Title Question Title * 5. Address Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Country: Question Title * 6. Telephone Question Title * 7. Email Address Question Title * 8. I am a Patient Physician/General Physician/Pulmonologist Nurse/Nurse Practitioner Physician Assistant Respiratory Therapist Pharmacist Public Health Professional Payer of Healthcare Services Pharmaceutical Company Employee Other (please specify) Question Title * 9. I heard about this workshop through COPD Foundation Florida Society for Respiratory Care Alpha-1 Foundation Alpha-1 Association American Lung Association of Florida Other (please specify) For more information please contact:Robert Sobkowiak at 305-926-7752, bsobkow@gmail.comorJamie Lamson at 1-866-731-COPD (2673) Ext.455, jlamson@copdfoundation.org Done