CTeL Fall 2019 Summit Registration

Welcome to the registration page for the CTeL Fall 2019 Telehealth Summit, December 4th-6th at The Willard Hotel in Washington, D.C.!

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* 1. Attendee Name:

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* 2. Attendee Organization:

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* 3. Title:

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* 4. Attendee Office Phone:

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* 5. Attendee Mobile Phone:

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* 6. E-mail:

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* 7. Attendee Organization Address:

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* 8. Attendee Home Address:

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* 9. Alternate Point of Contact:

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* 10. Alternate Point of Contact E-mail Address:

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* 11. Alternate Point of Contact Phone Number:

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* 12. If CTeL organizes an advocacy day, are you interested in attending meetings with your member of Congress or their staff?

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* 13. If CTeL organizes a briefing from members of Congress, are you interested in attending?

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* 14. If the CTeL Telehealth Stakeholder Group is invited back to the White House would you be interested in attending?

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* 15. Do you require any special food accommodations?

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* 16. Are you attending the Summit both days, December 5th and December 6th?

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* 17. Will you require a hotel room for your stay? *Please note that attendees are responsible for making reservations directly with the hotel. 

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* 18. If you will need a hotel room, what date to you plan to check in on and how many nights will you stay? * Please note that attendees are responsible for making reservations directly with the hotel.

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