Please fill out the following information to register for the "Innovative Methods to Integrate Tobacco Treatment into Clinical Practice" training program. Please fill out the survey for each participant. If an organization is sending multiple participants, each person should have a separate registration survey.

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* 1. Participant Name

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* 2. Participant Organization and Department (e.g. Auburn Community Hospital, OBGYN or Cayuga Seneca Community Action Agency, Healthy Families)

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* 3. Participant Email Address

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* 4. Which form of continuing education credit do you need?

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