Exit 2019 History of Medicine Interest and Pre-Registration Question Title * 1. FIRST NAME / Nome di battesimo Question Title * 2. LAST NAME / Cognome Question Title * 3. EMAIL Question Title * 4. Profession/Area of Interest MD/DO DDS/DMD DPM PA/NP Other Medical Professional Professor/Instructor Historian Artist Educational Enthusiast Other (please specify) Question Title * 5. This program would be of interest to many, however, for no additional fee are you interested in receiving 34 AMA PRA Category 1 Credits for this experience? Yes No Question Title * 6. Check all that apply. I am interested in: The Medici Family History Medicine Crime Scene Investigation The Renaissance Art Anatomy Question Title * 7. While at the conference, in Florence, if possible I would also like to experience more about... Question Title * 8. I will be attending on my own for personal interest on my own for professional development with others that are seeking professional development with others for their personal interest Question Title * 9. Fees will be collected after you begin the formal registration process. We will contact you via shortly after you complete this survey. The conference does not include airfare or hotel, however we have some economic suggestions for hotels that we can recommend. If you wish any discussion through an e.mail or a phone conversation, send your questions or leave us a number and a day and time (with zone) to call at info@charteredprofessors we would be glad to discuss your concerns. Done
