HAS21 - Faculty Invitation - Promedica International CME

Faculty Invitation

The Houston Aortic Symposium: Frontiers in Cardiovascular Diseases

The Fourteenth in the Series

March 11, 12 & 13, 2021
The Westin Oaks | Houston, TX
Name*
Please enter your name in the spaces provided below exactly as you would like it to appear in the brochure.
First Last
Degree(s)*
Enter the degrees/credentials you would like to appear after your name on the meeting brochure.
Salutation*
Please indicate if you will be able to participate as a faculty member in the symposium, which will take place March 11, 12 & 13, 2021 in Houston, Texas*
If your answer is "no", please answer below and then skip to the end of the form and click "Submit".

If you are able to participate, please complete the fields below. If not, please skip to the bottom and click "submit".
Please provide up to three (3) lecture topics/titles that you would be interested in presenting at the symposium. When the program directors have reviewed and chosen the topic they would like to include in the program, we will send you the final agenda via email.
Lecture Topic #1*
Lecture Topic #2
Lecture Topic #3
Comments
If you have any comments or questions, please let us know in the space provided below.
Please enter your contact information below. We will be in touch with the scientific program when available as well as a packet of faculty information and paperwork.

The hospital/institution, city, and state entered below will be printed in the forthcoming brochure as your affiliation.
Hospital/Affiliation
Physical Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Enter Email Confirm Email
Assistant's Email Address
If you would like us to include your assistant on meeting correspondence, please add their email here.
Phone Number
Fax Number

Faculty Invitation