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CAHIP NorCal Chapter Event Registration Form
Please complete the following form
at least
six weeks
before
the event date. A CAHIP NorCal official will be in touch ASAP to confirm your registration once it has been submitted.
Event Name
Event Date
Speaker Name
Speaker Email
Speaker Bio
Speaker Headshot
Presentation Topic
CE Credit Option?
Yes
No
DOI Approved Course #
Presentation Overview
In-Person or Virtual?
In-Person (Please complete location below)
Virtual (Webinar link will be provided)
Event Location
Location Address
Event Start Time
Event End Time
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