IMPACT Live - Stroke - Request a Meeting

Request an IMPACT Stroke Program

Personal Information

First Name:

Last Name:

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Prefix (e.g. Ms., Dr.):

Hospital/Affiliation:

Degree (e.g. MD, PhD, N/A):

NPI# (Physicians - New CME Requirement):

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State License Number:

Contact Information

Work Address :

Address:

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Work Phone (e.g. 123-456-7890):

Work Fax (e.g. 123-456-7890):

Mobile (e.g. 123-456-7890):

Program Request Information

Event Format:

Topic:
Time is Brain in the Management of Hemorrhagic Strokes
Case Studies in Hemorrhagic Stroke Management – What Should Be Done?
The Importance and Value of Comprehensive Stroke Centers
Managing Intracranial Hemorrhages in the Presence of Anticoagulation

Program Location - Restaurant or Address (optional):

Program Location - CITY or TOWN:

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Please select End Date if date range:

Number of Expected Participants:

Event Type:
Public
Private

Public Event - date and details will be posted on MedEdOnTheGo.com so HCPs in your area may have the opportunity to register.