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UAMS Department of Pediatrics
Professional Development Day Registration
August 22, 2017 12:00 pm - 4:15 pm
Please fill in your information below. Thank you!
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1.
What is your first name?
2.
What is your last name?
3.
Highest Degree:
Bachelors Degree
Masters
PhD
MD
Other (please specify)
4.
What is your phone number?
5.
What is your mailing address?
Street Address
City
State
ZIP
6.
What is your email address?
7.
CME Credit requested?
Yes
No
8.
What is your profession?
Physician
Nurse
Pharmacist
Social Worker
Student
Administration
Other (please specify)
9.
Affiliation:
Arkansas Children's
UAMS
Other (please specify)
10.
Have you attended the Professional Development Day conference before?
Yes
No
Current Progress,
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