Form – Quarterly Meeting Registration

"*" indicates required fields

After completion of this registration form, the participant will receive the Zoom meeting information in an email.

Please select the meeting:*

January 16, 2024; 5 PM – 7 PM ONLY

Please sign me up for all upcoming quarterly meetings (a recurring Outlook meeting invite will be sent)

Participant Name*

First Last

Participant Email*

We will send your registration confirmation and event correspondence to this e-mail address. Please enter an e-mail address that you check often.

Enter Email Confirm Email

WARNING: OPQIC sometimes encounters difficulties sending to HOTMAIL, AOL, and YAHOO users. If possible, please enter an alternative email address above.

Participant Credentials

Participant Job Title*

Hospital/Organization*

If your hospital or organization is not listed, please select Other at the bottom of the list.

Please enter the name of your Hospital/Organization*

Do you have any specific questions that you would like OPQIC to address?