2024 COF Symposium Blood Drive Event Registration Form
Please fill out the form to register for the PACE 2024 COF Symposium USPHS Categories Lifeblood Challenge.
1. Full Name
*
First Name
Last Name
2. Are you a USPHS officer?
*
Yes - proceed to question 3
No - proceed to question 8
3. Rank
4. SERNO
5. USPHS Category
Please Select
Dentist
Dietician
EHO
Engineer
HSO
Nurse
Pharmacist
Physician
Scientist
Therapist
Veterinarian
6. Agency
7. Location of Duty Station (City, State).
8. Email Address
*
example@example.com
9. Are you attending the 2024 COF Annual USPHS Scientific & Training Symposium?
*
Yes - registration complete, submit form
No - proceed to question 10
10. If completing your donation at a location outside of the Symposium, please upload pictures/documentation of your blood donation (from June 24 - 25, 2024) or email to LT Grace Vixama (qkl6@cdc.gov)
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