Please complete this form to receive a CME credit certificate.
Confirm sessions attended for CME credit(s) by checking the appropriate boxes.

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* 1. FRIDAY, AUGUST 1

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* 2. SATURDAY, AUGUST 2

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* 3. SUNDAY, AUGUST 3

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* 4. Which credits are you applying for?

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* 5. How would you like to receive your certificate of completion?

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* 6. Participant Name (First and Last Name)

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* 7. Clinic Name (if applicable)

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* 8. Phone Number (Optional)

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* 9. Comments/suggestions:

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