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Let's Talk About the Flu Workshop - Leader's Summary

1.Information about the Organization that planned the Workshop. (This is NOT information about the location of the where the workshop was held, but about the Organization that planned it.)(Required.)

Name of Organization

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

2.Where was the Workshop held? (location information)(Required.)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

3.When was the Workshop held?(Required.)

Date / Time

Date

SuSunday

MoMonday

TuTuesday

WeWednesday

ThThursday

FrFriday

SaSaturday

Hour

Time

:

Minutes

AM/PM

4.Who led the Workshop?(Required.)

Name (first and last)

Company/Organization

Email Address

Phone Number