Annual Meeting 2020 Evaluation - Saturday, November 21 Contact Information Question Title * 1. Please provide your contact information. Name: * Address: Address 2: City/Town: State: -- 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: Email Address (Certificates sent via e-mail): Phone Number: Question Title * 2. Are you a: Physician (on Medical Staff) Fellow Resident CNP/RN Other (please specify) Question Title * 3. Specialty: Primary Care Medical Sub-specialty Surgeon Other (please specify) Question Title * 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) Question Title * 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) Question Title * 6. For Non-physicians: Would you like a certificate of attendance? Yes No Next