Annual Course: QuestionnairePlease be sure to click the "Submit” button (below) and complete Step 3 (Early or Late Registration) at the bottom of the course page). Thank you for joining us! Name * First Name Last Name How do you say your first name phonetically? Please write your first name as it sounds, so that Kelly can say it correctly. What participant name will you be using on Zoom? This helps Kelly identify participants and ensure the security of our meeting. Email * Phone * For emergency purposes Country (###) ### #### How do you plan to participate? * Live, Online Self-Study (Video Recordings) Both Gender * Female Male Nonbinary Occupation If you're a healthcare worker, are you registering for Continuing Education (CE) Credits? Yes No Have you worked with Kelly before? * Yes No How did you hear about this course? * (If you were referred by a friend, please mention that person's name.) What is your primary motivation for taking this course? Do you have any concerns about participating in the course? If so, please describe. Is there anything else you'd like us to know? Thank you! Your questionnaire has been submitted. Be sure to complete Step 2 - Registration (at the bottom of the Annual Course page). After that, check your inbox for a confirmation email. It contains everything necessary for participation — whether live or self-study.
