Experts in Arthritis Registration Form - New Orleans, LA

1. Experts in Arthritis Seminar

 
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Please join us for an afternoon with world-class experts in arthritis care who will inform you about current scientific evidence and management strategies in the treatment and care of osteoarthritis, rheumatoid arthritis, and juvenile arthritis.

Date:______May 22, 2012_____

Time:________2:00 to 5:00 PM__

Location:__Tulan Medical Center,New Orleans, LA
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1. Please Register Below:
2. What is your relationship to the disease?
3. What is your area of interest?
4. Please list a question(s) you would like the experts to answer.
5. How did you hear about the seminar?
PHOTO RELEASE
I hereby grant the U.S. Bone and Joint Decade/Initiative and its affiliates specific permission to reproduce, publish, circulate copyright or otherwise use any and all photographs and/or electronic reproductions (slides, video) of myself taken at the Experts in Arthritis Seminar.

Signature:______________________________________________

Print Name:_____________________________________________

Date:__________________________________________________
6. Would you be interested in obtaining updated information regarding arthritis and related diseases?
7. For Office Use Only: Attended Session
YesNo
Attended