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  (for multiple selections, hold down the control button) Other areas of clinical interest: Which conference(s) would you like a brochure on? The following information is optional. Your answers are appreciated and assist us in better aligning our conferences with the needs of our attendees. Are you in private practice? How did you hear about our conference? My clinical area of interest is: Have you attended a summit before? Other way you heard about our conference: * = Required field Comments: *Email: Phone: Eve. Phone: *Zip: Country: *City: Fax: *Address: *State: Facility: *Credentials: *Last Name: *First Name: