Exit this survey NYC Case Studies March 11, 2015 Registration In order to register for this event, please provide the following information. You MUST register using the attendees name, contact information and their email address. If you complete the form multiple times with the same name and email address it will considered duplicates and all but one will be deleted. If you have any questions please email Mia.Freedenfeld@heart.org. Question Title * 1. These questions are required for us to register you in the AHA/ASA Professional Education Center, where you will complete the post event evaluation and claim your CME/CE Credit.Please type your information with appropriate upper and lower case characters. Please do not use all caps or all lower case as this information will be used as it is entered. You must complete all the fields in this question in order to move forward - if you would like to leave a field blank please indicate so by typing n/a in the field. First Name Middle Name Last Name Credentials Job Title Affiliation Address City State Zip code Email Address Telephone (Day Time Number) Question Title * 2. Have you previously registered for and American Heart /Stroke Association course? Yes No Question Title * 3. Primary Classification Administrator Certified Professional in Health Care Quality EMT/Paramedic Non-Healthcare Professional Nurse Nurse Practitioner Occupational Therapist Other Pharmacist Physician Physician’s Assistant Registered Dietitian Research Scientist Respiratory Therapist Technician/Technologist Question Title * 4. Secondary Classification Administrator Certified Professional in Health Care Quality EMT/Paramedic Non-Healthcare Professional Nurse Nurse Practitioner Occupational Therapist Other Pharmacist Physician Physician’s Assistant Registered Dietitian Research Scientist Respiratory Therapist Technician/Technologist Question Title * 5. Customer Segment Student Early Career Other Question Title * 6. Primary Specialty Administration Cardiology Emergency Medicine Epidemiology Family Practice Hypertension Internal Medicine Neuro/NeuroScience Other Pharmaceutical Industry Pharmacology Rehab/Exercise Surgery Thrombosis Vascular Medicine Question Title * 7. Secondary Specialty Administration Cardiology Emergency Medicine Epidemiology Family Practice Hypertension Internal Medicine Neuro/NeuroScience Other Pharmaceutical Industry Pharmacology Rehab/Exercise Surgery Thrombosis Vascular Medicine Question Title * 8. If you have any special dietary requirements, or if you require auxiliary aids or services as identified in the Americans with Disabilities Act, please note your needs below. We encourage participation by all individuals. You must click the submit button to complete your registration. You will receive an email with your registration confirmation - emails are sent out on Wednesdays. Done