NYC Case Studies March 11, 2015 Registration

In order to register for this event, please provide the following information. You MUST register using the attendees name, contact information and their email address. If you complete the form multiple times with the same name and email address it will considered duplicates and all but one will be deleted. If you have any questions please email Mia.Freedenfeld@heart.org.

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* 1. These questions are required for us to register you in the AHA/ASA Professional Education Center, where you will complete the post event evaluation and claim your CME/CE Credit.

Please type your information with appropriate upper and lower case characters. Please do not use all caps or all lower case as this information will be used as it is entered.

You must complete all the fields in this question in order to move forward - if you would like to leave a field blank please indicate so by typing n/a in the field.

First Name

Middle Name

Last Name

Credentials

Job Title

Affiliation

Address

City

State

Zip code

Email Address

Telephone (Day Time Number)

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* 2. Have you previously registered for and American Heart /Stroke Association course?

Yes

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* 3. Primary Classification

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* 4. Secondary Classification

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* 5. Customer Segment

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* 6. Primary Specialty

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* 7. Secondary Specialty

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* 8. If you have any special dietary requirements, or if you require auxiliary aids or services as identified in the Americans with Disabilities Act, please note your needs below. We encourage participation by all individuals.

You must click the submit button to complete your registration. You will receive an email with your registration confirmation - emails are sent out on Wednesdays.