2017 Patient Advocates Summit Interest Survey

Thank you for your interest in our second Annual Preeclampsia/HELLP Syndrome Patient Advocates Summit! This two-day summit will be an exciting experience for preeclampsia and HELLP syndrome survivors to come together for fellowship and learning.

The Summit will tentatively be schedule from Friday, October 13, 2017 through Sunday, October 15, 2017. Participants will be required to provide their own travel and lodging, but meals will be provided.

The following are a few questions we have for you about your interest in attending and where you'd like to see us host the event this year!

Please be sure to provide your contact information so that we can keep in touch when registration for the conference goes live.

Question Title

* 1. Please provide your contact information.

First Name: *

Last Name: *

Address:

City/Town:

State:

ZIP:

Country:

Email Address: *

Question Title

* 2. In what city would you most like to see the 2017 Patient Advocates Summit held?

Boston

Chicago

Dallas

Orlando

Philadelphia

Washington, DC

Question Title

* 3. Are you interested in attending the Advocates Summit?

Yes

Other (please specify)