2018 Heartbeat Conference Workshop Submission Presenter Information Question Title * 1. Contact Information First and Last Name: * Organization: * Address: * Address 2: City: * State: * Zip: * Country: * Email Address: * Cell Phone Number: * OK Question Title * 2. If applicable, assistant's information: Asst. Name: Asst. Email Address: Asst. Phone Number: OK Question Title * 3. Please list any credentials/professional designation (i.e, LAS, Ph.D., R.N., etc...) OK Question Title * 4. If with a pregnancy help organization, is it an affiliate of Heartbeat International? Yes No N/A OK NEXT