Osteogenesis Imperfecta TeleECHO Registration Question Title * 1. Name OK Question Title * 2. Email Address (Please check for typos) OK Question Title * 3. Phone Number OK Question Title * 4. Your Institution Institution Name Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country OK Question Title * 5. Your Job Title OK Question Title * 6. Credentials (Please check all that apply) MD Resident PhD Fellow PA RN NP PharmD Medical Student Other (please specify) OK Question Title * 7. How did you learn about the OI ECHO? An email A professional conference/meeting From a colleague Other (please specify) OK Question Title * 8. Are you interested in gaining CME credit for attending the OI ECHO? Yes No OK Question Title * 9. Are you interested in presenting patient cases during future teleECHO clinics? Yes No OK Question Title * 10. If yes, during what session(s) would you prefer to present your case(s)? OCTOBER 14, 2020 -- Diagnosis and Genetic Testing NOVEMBER 11, 2020 -- Lower Extremity Rodding/Coxa Vara DECEMBER 9, 2020 -- Medical Treatment in Children JANUARY 13, 2021 -- Upper Extremity Rodding FEBRUARY 10, 2021 -- Medical Treatment in Adults MARCH 10, 2021 -- Scoliosis APRIL 14, 2021 -- ENT/Hearing MAY 12, 2021 -- Dental and Orthodontics JUNE 9, 2021 -- Pulmonary Issues JULY 14, 2021 -- Basilar Invagination· AUGUST 11, 2021 -- Women's Health: Pregnancy and OI SEPTEMBER 8, 2021 -- Challenging Orthopedic Topics OK DONE
