Get January 14, 2011 Dear Colleague, As Part Of Our Ongoing Efforts To Create And Maintain A Strong

This guide provides clear and comprehensive instructions on how to fill out the January 14, 2011 Dear Colleague form for the Medical Director's Summit. Designed for healthcare professionals, this document aims to facilitate participation in an important dialogue regarding healthcare issues.

Follow the steps to complete your registration form.

1. Click the ‘Get Form’ button to access the registration form and open it in your preferred document editor.
2. Fill out your last name in the designated field. Ensure that the information is legible.
3. Next, enter your first name in the appropriate field. This will help identify you during the summit.
4. In the section for preferred name on the badge, write the name you would like displayed during the event.
5. Specify your title in the corresponding field to provide context regarding your professional role.
6. Complete the agency name section with the name of your workplace.
7. Indicate your parish in the next field, as this information is important for local engagement.
8. Fill out the agency mailing address, ensuring that all parts of the address are included.
9. Provide the city, state, and zip code for the mailing address to ensure accurate contact information.
10. Enter your office phone number, fax number, and email address in the designated fields.
11. Check the box to indicate if you would like to be added to the distribution list for updates from the Department of Health and Hospitals.
12. If you wish to register for the event on February 16, 2011, mark the corresponding checkbox.
13. Optionally, you may provide any questions or topics of interest in the related fields. This information may enhance future sessions.
14. Once all fields are filled, review for accuracy, and ensure that the document is legible.
15. Submit the completed registration form by faxing it to Karen Stassi at 985-796-1672 or emailing it to Karen.Stassi@la.gov by the registration deadline on February 11, 2011.
16. After submission, you may save a copy of the completed form for your records, and note any upcoming communications regarding the event.

Complete your registration online to secure your participation in the Medical Director's Summit.