Name *
Email *
Degree	Please Select BS BA BSN DO MA MD MS MSN None NP Other PA PharmD PhD RN RPh
How many HIV prescriptions did you write last month? *
If you do NOT write prescriptions, do you consult with those that do, and how? *
What kind of patient contact do you have? *
How did you learn about this program? *	Yes   No
Please check the reason(s) you would like to attend this meeting *	Information Update Speakers CME Credits
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