Open Meeting Presenter Registration Survey

Attending as an Observer?

This registration form is for presenters only.
Please use one of the observer registration links below to register as an attendee.

JN First Coast WebEx Observer Registration

JH/JL Novitas WebEx Observer Registration

Meeting Details

JN First Coast Open Meeting
Thursday, November 19
1pm ET

JH/JL Novitas Open Meeting
Friday, November 20
10am ET / 9am CT / 8am MT

1.Which meeting will you present at?(Required.)

First Coast (November 19)

Novitas (November 20)

Both meetings

Presentations will be reviewed jointly by First Coast and Novitas regardless of the meeting selected.

2.Please complete the following:(Required.)

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

3.Your company and title:(Required.)

Company

Title

4.Which proposed Local Coverage Determination (LCD) will you be presenting on?(Required.)

Sacroiliac Joint Nerve Blocks

5.Presentations will be conducted via webinar.

No response required.

6.Do you require any accommodations to participate in the webinar?(Required.)

Yes

No

If yes, please describe any accommodations needed.

7.Will you be using presentation slides?

Yes

No

Presenter Reminder
Presentation materials will be requested prior to the meeting.

Additional information will be requested by First Coast/Novitas following registration via the email address provided above.

Open Meeting Presenter Registration

First Coast Service Options and Novitas Solutions, Inc.