Rep Request Form

Peer Education Events for HCPs

Please complete the form below to request a Local Education Program to educate HCPs. 

MM slash DD slash YYYY
Note: Live events should ideally have between 5-20 attendees. Virtual Events can have any number of attendees.
Who is being educated? Select all that apply.
Treaters
COPD Clinicians - Pulmonology
COPD Clinicians - Primary
This request will go to your RBD for their review. Your RBD will route all further approvals. The event should not be considered to be confirmed until Marketing has notified you that faculty has been secured and has provided you with an approved invitation.


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