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Telephone Conference Site Response Form

Breakthrough Bleeding

Mechanisms and Management of Breakthrough Bleeding on Oral Contraceptives

December 13, 2007
12 – 1pm Central Standard Time
1 – 2pm Eastern Standard Time

Complete one form for each registered site (not each participant) after the December 13th presentation

SITE COORDINATOR
First Name:
Last Name:
Agency:
City:
State:
Zip:
Please rate (check your response):
 
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Total # participating from your site (whether from home or office):
Did your staff encounter any barriers to participating in this program?
If yes, please explain:
Suggestions for future telephone conferences:
Additional Comments:




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414.224.5270
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