Heart Function Support Group Enrollment Question Title * 1. Personal Information Name Email Address Phone Number Question Title * 2. Preferred form of Contact Phone Email Question Title * 3. Location you plan to attend Kennestone- Advanced Heart Failure at Kennestone: 175 White Street, Suite 100, Marietta, GA 30060 Paulding Hospital- Atrium Conference Room: 2518 Jimmy Lee Smith Pkwy, Hiram, GA 30141 Cobb Hospital- North Professional Bldg, Oran Conference Room: 1791 Mulkey Rd, Austell, GA 30106 Virtual for select sessions on Microsoft Teams Done