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Partner Event Registration Form

To create a new event, please fill out the appropriate fields below. If you wish to update a current registration with new information or add a new activity please contact the Registry Administrator.

Completing this form indicates your willingness to post your activities for public use. Before we can post your activities, you must identify yourself so that we can verify or clarify any information if necessary. The NHLBI will use your personal information only in the ways indicated in our Privacy Statement.

Only activities that feature COPD will be accepted. Submissions that promote businesses or commercial activities or products will not be accepted.

Registration information will be reviewed by NHLBI prior to posting. Events will not post to the Web site immediately, please enter your information only once.

Activity Title:

Activity Sponsor:

Activity Location (Street Address, City, State, Zip Code):

State:

Activity Description

Please write a brief explanation of your event including the time, location, and contact information. This description will be posted on the web exactly as you enter it.

Start Date:

Please fill in the start date: MM/DD/YY

/ /

Finish/End Date:

Please fill in the finish date: MM/DD/YY

/ /

Start Time:

Please fill in the start time: 00:00

End Time:

Please fill in the end time: 00:00

Check if this is a reoccurring event

How often is this event?

Example: First Tuesday of every month at 8pm

Contact Information:

Completing this form to list your event description on this Web site is voluntary. However, before we can post your activity, you must identify yourself so that we can easily verify or clarify any information if necessary. The NHLBI will use your personal information only in the ways stated in our Privacy Statement.

First name: (Required)

Last name: (Required)

Organization: (Required)

Address 1: (Required)

Address 2:

City: (Required)

State: (Required)

Zip: (Required)

Telephone: (Required)

Fax:

Email: (Required)