General Information

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* 1. Name of Institution:

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* 2. Proposal Submitted by:

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* 3. Email Address:

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* 4. Phone:

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* 5. Have you hosted a live case presentation at your current institution in the past 24 months?

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* 6. Are you familiar with the Heart Rhythm Society's Statement on the Use of Live Case Demonstrations at Cardiology Meetings?

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