Exit Evening with a Scholar Registration Form Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. Email Question Title * 4. Company/Organization Question Title * 5. Are you planning to attend Dr Hartmann's presentation in person in North Haven or via Zoom? in-person on Quinnipiac North Haven Campus via Zoom not sure yet Question Title * 6. Please indicate your professional role OT Practitioner OT Student OT Faculty Other (please specify) Question Title * 7. Are you interested in receiving more information about Quinnipiac's Post Professional OTD program? Yes No Question Title * 8. If you are a member of ConnOTA you may be able to receive continuing ed hours for your attendance at this event. Are you a ConnOTA member? Yes No Thank you for registering for Quinnipiac OT Evening with a Scholar with Kimberly Hartmann! Watch your e-mail for further event details. Done