Video/Presentation Release Form

The Houston Aortic Symposium - February 23, 24 & 25, 2017

The Houston Aortic Symposium: Frontiers in Cardiovascular Diseases, the Tenth in the Series symposium may be filmed by Promedica International CME for educational purposes. Please complete this form to indicate if you give permission for your presentation(s) to be filmed and for your slides to be shared online in a protected file.
Name*
First Last
Permission*
- Yes, I give my permission
- No, I do not give my permission
Electronic Signature*
- Check this box to provide your electronic signature
Date*
MM slash DD slash YYYY