Registration for the Parents Primer Series
"Sprains, Breaks, and Brains"
Questions marked with an asterisk (*) are mandatory.
1
*
Contact Information (required)
First Name:
Last Name:
Address Line 1:
Address Line 2:
City/Town:
State:
Zip Code:
Phone Number:
Email Address:
2
Number of attendees
3
Number of children in your household
4
Ages of children
5
How did you hear about this event?
Doctor's office
School/daycare
Newspaper
Other, please specify
6
* Would you like to receive an email reminder about this event?
7
* Would you like to receive email updates from Comer Children's Hospital about future news and events?
