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COPD Summit Registration Form

7.COPD Summit Registration Form

1.Select the Summit that you are registering for.
For more information on the Southeast Regional COPD Summit Visit:
http://www.copdfoundation.org/NewsEventsNEW/UpcomingEvents/tabid/172/vw/3/ItemID/15/d/20101115/language/en-US/Default.aspx


For more information on the MA COPD Summit visit:
http://www.copdfoundation.org/NewsEventsNEW/UpcomingEvents/tabid/172/vw/3/ItemID/12/d/20101109/language/en-US/Default.aspx
2.Name(Required.)
3.Credentials
4.Organization(Required.)
5.Title
6.Address
7.Telephone #
8.Email Address(Required.)
9.I am a(Required.)
10.I heard about the Summit through(Required.)
The Southeast Summit is sponsored by Boehringer Ingelheim Pharmaceuticals, Inc.

The Massachusetts COPD Summit is sponsored by Boehringer Ingelheim Pharmaceuticals, Inc.

Meal expenses are sponsored by the COPD Foundation.


For more information please contact Jamie Lamson at
1-866-731-COPD (2673) Ext.455, jlamson@copdfoundation.org