In-Person Event Interest Form
Name
*
Email
*
What is your primary role in the company?
*
Administrative
Billing
Clinical Care
Management
Other: Please Specify
Other: Please specify your primary role
*
What types of topics would you be most interested in for future events?
*
Admin Processes
Billing Processes
Clinical Processes
Fabrication Processes
Other: Please Specify
Other: Please specify other topics
*
What U.S. geographical areas do you prefer for an in-person event?
*
Please select all that apply.
Midwest - East North Central
Midwest - West North Central
Northeast - New England
Northeast - Mid Atlantic
South - South Atlantic
South - East South Central
South - West South Central
West - Mountain
West - Pacific
Would you like to be added to our email list to receive notifications about future in-person events?
*
Yes
No
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