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

General Information

Question Title

* 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.)

Name of Organization *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code

Question Title

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

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Question Title

* 3. When was the Workshop held?

Date / Time

Date

Time

AM/PM

Question Title

* 4. Who led the Workshop?

Name (first and last) *

Company/Organization

Email Address *

Phone Number *