IEP Webinar Registration for 10-14-15 or 10-22-15 or 11-10-15

IEP Oct and Nov 2015 Webinar Registrations

Wednesday, Oct 14, 2015 or Thursday, Oct 22, 2015 or Tuesday, November 10, 2015
Time: 12:15 pm - 1:30 pm (EST)

Webinar, phone link, CME/CEU information, and handouts will be emailed to registrants prior to the event.
Questions starred below (*) require answers.

Question Title

* 1. Which Webinar are you registering for?

10-14-2015, 12:15 PM -1:30 PM

10-22-2015, 12:15 PM -1:30 PM

11-10-2015, 12:15 PM -1:30 PM

Question Title

* 2. Name, email, phone

First Name

Last Name

Degree

Email Address (required for handouts)

Phone

Question Title

* 3. Practice, hospital, school, business, or other organization name:

Name

Address 1

Address 2

City

State

Zip

County

Question Title

* 4. Specify pediatric, family medicine, or other practice type

Pediatric

Family medicine

Other medical practice

School nurse

Public health department

Other (please specify)

Question Title

* 5. Expected number of participants from my site. (If only you, then "1")

Question Title

* 6. My practice will join by: Please check one

Webinar (one computer connection with sound accessible by phone). Webinar space is limited. Once webinar slots are filled, participants will only be able to listen by phone and use the handouts emailed to you.

Teleconference only (via phone only). Handouts will be emailed to you.

Question Title

* 7. Specific questions you would like to see addressed by the speaker on this webinar/teleconference.
Your handouts and connecting instructions will be emailed to you.
We look forward to your participation!

Question Title

* 1. Which Webinar are you registering for?

Question Title

* 2. Name, email, phone

Question Title

* 3. Practice, hospital, school, business, or other organization name:

Question Title

* 4. Specify pediatric, family medicine, or other practice type

Question Title

* 5. Expected number of participants from my site. (If only you, then "1")

Question Title

* 6. My practice will join by: Please check one

Question Title

* 7. Specific questions you would like to see addressed by the speaker on this webinar/teleconference. Your handouts and connecting instructions will be emailed to you. We look forward to your participation!

* 7. Specific questions you would like to see addressed by the speaker on this webinar/teleconference.
Your handouts and connecting instructions will be emailed to you.
We look forward to your participation!