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* 1. Program Title:

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* 2. Program Date:

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* 3. How many years have you been in practice?

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* 4. How would you describe the information presented at this program?

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* 5. The speakers demonstrated expertise on the topics.

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* 6. Which presentations provided the most valuable tips or strategies for you to employ in your practice and why?

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* 7. How would you improve this program? What additional topics or speakers would you have included? 

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* 8. Your Name (optional)

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* 9. City/State of your practice (optional)

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* 10. May we quote you?

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* 11. Please rate and comment on each speaker at this program.

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* 12. Do you have any additional comments?

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