Lupus Education Sessions Registration
First Name:
Last Name:
Email Address:
Phone:
Specialty:
Degree/Credentials:
Affiliated Practice:
City of Practice:
State of Practice:
Years in Practice:
0 - 5 Years
6 - 10 years
Greater than 10 years
Seminar Date (choose one):
Tuesday, August 24, 1:30-2:15 p.m.
Thursday, September 2, 1:30-2:15 p.m.