Thank you for your interest in joining HCPLive's Clinical Forum. Please complete the form below to request participation in the meeting.

To be eligible to attend this meeting, physicians must be practicing nephrologist, cardiologist, PA, or NP treating patients for Chronic Kidney Disease, and located in the US.

Please note: This forum is VIRTUAL only.

We will promptly review your information and let you know if your registration is approved.

First Name*

Last Name*

Email Address*

Mobile number*

Street Address*

Country*

City*

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Zip Code*

Primary Degree*

Employer / Institution *

Occupation*

Job Title*

What is your primary specialty?*

Workplace Setting*

Please enter your NPI number (Optional).

Did you receive an invitation for this meeting directly from the Moderator?*

If yes, please provide the name of the moderator that invited you to this meeting.

Did you receive an invitation for this meeting directly from a colleague?*

Please provide the name of the colleague that invited you to this meeting. If not applicable, please write N/A.*

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By attending a HCPLive® Clinical Forum ("Event"), all participants, attendees, sponsors, and guests ("you") create an agreement between you and HCPLive® regarding the use and distribution of your image, including but not limited to your name, voice, and likeness ("Image"). By attending the Event, you acknowledge and agree that photographs, video, and/or audio recordings may be taken of you and you grant permission to HCPLive® (and its agents) to utilize, in perpetuity, your Image in any electronic or print distribution, or by other means hereinafter created, both now and in the future, for any lawful purpose as determined by HCPLive®.

<div style="text-align: center; font-size:22px;"> Thank you for your registration request. </div> <p style="text-align: center;"><br /></p> <p style="text-align: center;">Your registration is currently being reviewed and has not yet been confirmed. We will review your registration request and be in touch within 5 business days.</p> <p style="text-align: center;">If you do not see an email regarding your registration status from hcplive@casebaseroundtable.com, please check you Spam/Junk folder.</p>

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