HAWAII COPD EVENT REGISTRATION FORMDate MM slash DD slash YYYY Name* First Last Organization (if any)Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email (optional) but needed for webevents like webinars Phone (optional)17th annual COPD Education Day, Friday, 9/8/2023, 9-12:30pm HST Yes, I will participate live at Queen's Conference Center Yes, I will participate online by Zoom, 10am-noon (link will be emailed to me) Sorry, I am unable to participateLung Health Support Groups on 2nd Fridays 10-noon HST Yes, I will be attending LIVE at Medical Library, Straub Strode-Milner Basement Yes, I will attend via zoom, meeting 863 0371 5868 passcode HIcopd No, I am unable to attend support group meetings at this time*Please Check as many of the following that applies to you. I am a: COPD Patient Caregiver Healthcare Provider Student Exhibitor VolunteerHow did you find out about this program? (Text Area)Stay Informed Keep Me Informed Send Me NewslettersEmailThis field is for validation purposes and should be left unchanged.Δ
