Telehealth Registration

Asthma Telehealth (a continuing education program for health professionals). Registration

All presentations are to be used for educational purposes only and will be protected under the Creative Commons Copyright philosophy. By registering for this program, you are giving permission and acknowledging that the program is going to be recorded, and all remote sites may at some time be recorded during question & answer periods.

A valid e-mail address is required, you will receive an e-mail confirmation once the on-line registration is completed.

Program materials, phone number and/or webstreaming link will be sent to you the day before the presentation.

Fields marked with (*) are required.

*Event Registering for:
*First Name: *Last Name:
*E-mail: Title:
 
*Participation Method:
Telephone
Web Streaming
Video Conference
*Site Location:
 
*Organization:
Address:
City: State:    Zip:
*Phone:
Fax: