Thank you for your interest in the Pediatric Pitfalls program being offered in person on March 28, 2026, 9 AM to 5 PM.

Please complete the following survey to register for this in-person class.

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* 1. First Name

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* 2. Last Name

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* 3. Organization/Agency Affiliation Name

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* 4. Organization/Agency Affiliation County

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* 5. Phone Number

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* 6. Email Address

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* 7. Date of Birth

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* 8. PA EMS Certification Number (if applicable)

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* 9. PA EMS Certification Level (if applicable)

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