CI21 - Faculty Invitation (Non-CME) - Promedica International CME

Faculty Invitation Form

32nd Annual Cardiovascular Interventions
November 16-19, 2021 • La Jolla, California
Your Name*
Enter your full name exactly as it should appear in the meeting materials.
First Last
Are you available to participate as a faculty member in the symposium?*
Faculty includes speakers, moderators, planners, peer reviewers, and course directors.

Yes, I agree to participate as a faculty member in the 32nd Annual Cardiovascular Interventions Symposium

No, I am unable to participate as a faculty member in the 32nd Annual Cardiovascular Interventions 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

Title(s) you would like to appear in the meeting materials*
Enter n/a if you do not want to include any titles.

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*
Do you give permission to the "32nd Annual Cardiovascular Interventions" 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
Please click "submit form" below to submit your decline to participate.

Faculty Invitation Form