MKSAP 18 Live Online Study Hall Registration Question Title * 1. Name Question Title * 2. ACP Number Question Title * 3. ACP Chapter Question Title * 4. Year your Board Certificate expires (Members) / Year you plan to take boards (Resident Members: IL Elite Status ONLY): Question Title * 5. How many times have you recertified in the past? * IL Residents ONLY-I am a Resident Member (or in a Fellowship program) preparing for boards Never; this will be my first time Once Twice More than two times My certificate has no term limit Other (please specify) Question Title * 6. Email address: Question Title * 7. Cell Phone (used only in case of emergency prior to a session): Question Title * 8. Mailing Address: Question Title * 9. * IL Resident Members ONLY: I am an Resident Member at one of the following Elite Status Residency Programs (Masters, Fellows, & Members can skip to the next question): Centegra Franciscan Loyola University MacNeal Hospital North shore University Health System Southern Illinois University University of Illinois, Chicago University of Illinois, Urbana/Champaign West Suburban Hospital Medical Center Question Title * 10. How did you hear about MKSAP Live Online Study Hall? Email Blast Flyer Colleague ACP Website Local Chapter Website Social Media Question Title * 11. Which of the following is true: I purchased MKSAP 18 specifically to participate in this webinar I already owned MKSAP 18 I planned to purchase MKSAP 18 and this webinar encouraged me to purchase Other (please specify) Done
