Please note: Participant seats are limited. Submitting this form does not confirm your registration. An email will be shared at a later date to confirm your registration.

Participants are required to attend both days.

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* 1. First Name (Please register with the name you would like to appear on your certificate)

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* 2. Last Name

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* 3. Email address (organization emails preferred)

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* 4. Profession

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* 5. Organization

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* 6. Part of the continuum (e.g. acute, inpatient, outpatient, etc.)

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* 7. What percent of your time do you work in stroke?

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* 8. I have discussed and received approval for the time commitment required for this workshop with my manager:

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* 9. Please provide your manager's email address:

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* 10. Indicate any food allergies or dietary restrictions:

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