Annual Meeting 2020 Evaluation - Saturday, November 21

Contact Information

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1. Please provide your contact information. (Required.)

Name: *

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address (Certificates sent via e-mail):

Phone Number:

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2. Are you a:

Physician (on Medical Staff)

Fellow

Resident

CNP/RN

Other (please specify)

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3. Specialty:

Primary Care

Medical Sub-specialty

Surgeon

Other (please specify)

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4. How did you hear about the meeting? (Check all that apply)

Email Blast

Ohio AAP Today

Ohio Pediatrics

Ohio AAP Website

Personal Referral/Colleague

Postcard in Mail

Other (please specify)

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5. What made you register for the meeting? (Check all that apply)

Interesting Topics

Need for MOC Part II Credit

Networking with Colleagues

Store It Safe Panel Presentation

Federal Legislative Update Presentation

Virtual Attendance Option

Participation in Related MOC Part IV Program

Reduced Cost

Other (please specify)

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6. For Non-physicians: Would you like a certificate of attendance?

Yes

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* 1. Please provide your contact information. (Required.)

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* 2. Are you a:

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* 3. Specialty:

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* 4. How did you hear about the meeting? (Check all that apply)

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* 5. What made you register for the meeting? (Check all that apply)

Question Title

* 6. For Non-physicians: Would you like a certificate of attendance?

1. Please provide your contact information. (Required.)

2. Are you a:

3. Specialty:

4. How did you hear about the meeting? (Check all that apply)

5. What made you register for the meeting? (Check all that apply)

6. For Non-physicians: Would you like a certificate of attendance?