CATCD21 - Faculty Invitation - Promedica International CME

Faculty Invitation Form

Controversies & Advances in the Treatment of Cardiovascular Disease: The Twentieth in the Series
December 2-3, 2021 • Beverly Hills, California
Your Name*
Enter your full name exactly as it should appear in the meeting materials.
First Last
Do you agree to be listed as a local faculty member for the symposium in the meeting materials?*

Yes, I agree to be listed as a local faculty member for the Controversies Symposium

No, I do not agree to be listed as a local faculty member for the Controversies Symposium

Email*
Enter the email where you would like to receive future meeting correspondence.
Enter Email Confirm Email

Degrees/Credentials*
Enter the degrees/credentials you would like to appear in the meeting materials.

Salutation*
Are you an FACC or MACC?*
Hospital / Affiliation*
Enter your affiliation to be listed in the meeting materials

Mailing Address*
Street Address Address Line 2 City State ZIP Code

Assistant's Email
If you would like us to include your assistant on meeting correspondence, please enter their email here.

Phone Number*
Phone Type*
Fax Number
Permission to share contact information as part of symposium attendee list*
Do you give permission to the "Controversies & Advances in the Treatment of Cardiovascular Disease: The Twentieth in the Series" symposium to share your name and contact information (address only, no attendee emails will ever be shared) with sponsoring companies as part of a symposium attendee list?

Yes, I give my permission

No, I do not give my permission

Faculty Invitation Form