Register to Speak | Health-Scripts

Name(Required)

First Last

Email(Required)

We will not spam you.

Mobile Phone(Required)

This is used for opt-in verification.

May we TXT you a confirmation?(Required)

Message and data rates may apply. Text ‘STOP’ to opt-out at any time.

Yes

No

Which best describes you?(Required)

What is your current practice name?(Required)

What is your practice specialty?(Required)

What is your current practice address?(Required)

Street Address Address Line 2 City State Zip Code

I understand the following:

By submitting this registration form, you expressly consent to our collection, use of your information as described in our Privacy Policy Statement and agree that you are an “opted-in” participant with us for the purpose of conforming with any applicable federal, state and local laws relating to solicitations via email, mobile phone, SMS TXT, and fax. By entering your mobile number, you consent to communications via TXT. In accordance with PhRMA Code of Interactions with Healthcare Professionals, attendance at this education program is limited to healthcare professionals. Accordingly, attendance by guests or spouses is not appropriate and cannot be accommodated. Due to certain state laws and regulations, if you: (1) have a license to provide healthcare in Minnesota, Vermont, or New Jersey or (2) are a member of a Medication Advisory Committee in the District of Columbia, please do not partake in any food and/or beverages available at this program. This is a promotional medical education presentation; it will not be certified for continuing medical education credit.

CAPTCHA

Email

This field is for validation purposes and should be left unchanged.

Share Your Clinical Experiences