101 Ways To Prevent Medical Errors

What format will you like your hospital seminar?

This is just a questionnaire about your preference, it does not mean you are ordering a seminar. If you are requesting more information about any of our seminars, please indicate in the big box below. 

Please indicate the seminar format you prefer

 1 option - In-house seminar in your own institution.

 2 option - joint seminar with other hospitals in a different location

 3 option - seminar in another closeby city.

 4 option- prefers an out of state seminar.

Your Name

Name of Your Institution

Address of Your Institution

City and Zip code

Your Job Title

Name of Your Department

What Seminar is of Interest to You?

 

Enter your seminar requests or comments in the space provided below:

Tell us how to get in touch with you: (Very Important)

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Please contact me as soon as possible regarding this matter.

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Revised: November 03, 2004.