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Statement of Interest

Please review the Statement of Interest posted here (http://www.fha.org/files/PFE/PFE-Statement-of-Interest.docx) and then complete the fields below.

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* 1. Selected track(s) for your hospital:

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* 2. Team Lead Contact Information:

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* 3. Team member contact information. Please include name, title, email address, and phone number for each individual below.

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* 4. Please help us plan future meetings. What content or topics would you like to have presented in an educational session or training in the future?

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