REGISTRATION - CoffeeTime Webinar: 1/08/2013
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To register for the Coffee Time Consultation Webinar, please provide the following information:
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1. First and Last name:
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2. Credentials: Select all that apply
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3. Practice Name:
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4. Check one:
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5. County where practice is located:
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6. Number of years in practice:
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7. Email addresses will be used to provide login and dial-in information, the webinar link, and any applicable handouts. Please provide your email address:
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8. Would you like to be notified about upcoming Coffee Time Consultation Webinars or other educational opportunities for primary care providers?
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