Registration: PA MHI Let's Talk: Opioid Crisis- 5/14/18 12:00 PM - 1:30 PM

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

Name, email, phone

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* 1. Name, email, phone

Your Professional credentials:

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* 2. Your Professional credentials:

Practice, hospital, or organization name:

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* 3. Practice, hospital, or organization name:

Specify pediatric, family medicine, or other practice or organization type

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

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

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

My practice/organization will join by: Please check one

Question Title

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

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

* 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!

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