Form CMS-10702 LAN Summit basic reg form

Virtual LAN Summit Registration Form

Single Text Field

Last Name*

First Name*

Title*

State* (drop down box)

Email Address*

Organization*

Drop down box

Primary Organization Type-

• Academics

• Communications

• Consultants

• Consumers/Patients

• Employers/Purchasers

• Government

• Insurers/Payers

• Professional Associations

• Providers

• Suppliers

• Other

Single text field

What key takeaways do you and/or your organization hope to gain from the 2022 LAN Summit? *

*Required field