This continuing medical education program is made possible through unrestricted educational grants from Gilead Sciences and Tibotec Therapeutics.

Please complete the information below to register.
 You will only need to fill this form out one time. It will ensure that you receive important communication regarding this program. If needed, please contact Richard Gordon at 847-951-5318

Virtual HIV Grand Rounds Registration
Your name *
Email address *
Degree/Profession *
Are you employed by a pharmaceutical company? * Yes No
If you answered "yes" you are employed by a pharmaceutical company, in what capacity are you employed?
City/Town *
Province/State or Not applicable *
Country *
Phone (for notification purposes only) *
What is the name of your clinic or institution? *
Are you registering as a group/clinic or individual? *
How many HIV-infected patients did you/your clinic see last month? *
If registering as a group or clinic, how many do you anticipate will attend the program?
What kind of patient contact do you have? *
Your comments
 
* Required

Thank you for registering, confirmation of your registration(s) will be sent by email within the next 24-hours.