Live Case Session: Request for Presentation General Information Question Title * 1. Name of Institution: Question Title * 2. Proposal Submitted by: Question Title * 3. Email Address: Question Title * 4. Phone: Question Title * 5. Are you familiar with the Heart Rhythm Society's Statement on the Use of Live Case Demonstrations at Cardiology Meetings? Yes No Question Title * 6. Please list potential cases for live presentation: Case Topic 1: Case Topic 2: Case Topic 3: Case Topic 4: Case Topic 5: Case Topic 6: Next