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Institute KOL Enrollment Form
HTRS is seeking interested members who are willing to speak during Institute Workshops for industry partners. Your time and travel will be compensated by the Institute program.
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* Indicates required question
1) Speaker's Name and Credentials
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Your answer
2) Speaker's Institute
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Your answer
3) Speaker's Address
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Your answer
4) Speaker's Email Address
*
Your answer
5) Speaker's Phone Number
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Your answer
6) Area(s) of Interest/Specialization
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Hemostasis
Thrombosis
Both
Other:
7) Focus
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Adults
Pediatrics
Other:
8) Research Interest
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Basic Science/Laboratory Research
Clinical Research
Translational Research
Other:
9) Key Topics or Areas of Expertise
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Your answer
10) Travel Limits or Constraints
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Your answer
Additional Comments or Information:
Your answer
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