June 10 Buprenorphine Waiver Training Registration
HFM Farley Conference Room
757 S Clinton Ave. Rochester NY
OK
1.
Name (first & last)
2.
Professional Degree
3.
Discipline
4.
Email address
5.
Your contact number
6.
Office Name
7.
Office contact name
8.
Office contact phone number
9.
Are you a resident?
Yes
No
10.
Are you an AHP member?
Yes
No
11.
Is your practice in a rural area?
Yes
No
12.
Is your practice in a medically under-served community?
Yes
No
13.
Are there any specific questions you would like to be addressed at this training?
14.
Food will be served at the training - do you have any dietary restrictions?
Current Progress,
0 of 14 answered