First Name
*
Last Name
*
Hospital
*
Job Function
*
Chair of Obstetrics
OB Director
Nurse Manager
Labor & Delivery Clinician
Chief Nursing Officer
Risk Manager
Clinical Educator
IT Manager
CFO
CIO
CMIO
Financial Manager
Informaticist
Obstetrician
Other
President/CEO
Purchasing
Quality Manager
City
*
State
*
AK
AL
AR
AZ
CA
CO
CT
Canada
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
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Other
Email
*
License
*
Current EFM
*
Cerner FetaLink
GE CPN
None
OBIX
Other
Paper
PeriGen PeriCALM
PeriGen PeriWatch
PeriGen WatchChild
Philips TraceVUE
AWHONN Location Preference
*
CE Reception Only
Booth Only
Reception & Booth
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