Questions marked with an asterisk (*) are mandatory.

1	* Which webcast would you like to attend? The July 26th session is now closed. Thursday, July 29, 2010 at 1:00pm EST (12:00pm CST) I'm unable to attend live, but would like to be sent a recording

2	* First Name

3	* Last Name

4	* Email Address

5	* Title

6	* Company Name

7	* There are _____ physicians in my practice? 1 - 3 4 - 25 25 - 100 100+ Not Applicable

8	* I am: An Allscripts EHR Client An Allscripts Non-EHR Client A Prospective Allscripts Client A Partner/Reseller A Consultant Other

9	If you answered 'Prospective Allscripts Client' and are interested in an Allscripts EHR, please indicate your estimated purchase timeline. 1 - 3 months 3 - 6 months 6 - 9 months A Year Year +

10	* Office Phone

11	* Address

12	* City

13	* State

14	* Postal Code