Events, Classes & Groups

Heart-to-Heart: Your Questions Answered Registration

Complete the form to register for the Heart-to-Heart: Your Questions Answered at Annenberg Health Sciences Building.

The fields with red asterisks * are required.
Your personal information is secure; see our notice of Privacy Practices for details.

First Name:*
Last Name:*
Address:
City:
State:
Zip Code:*
Please provide your Zip Code to assist us in planning future class offerings
Gender:
1. Male
2. Female
3. Prefer not to say
4. Prefer to describe myself as
Please provide the Gender with which you associate.
Email:*
A registration confirmation will be emailed to this address
Phone:*
Please provide your best contact number. This would only be used if there are class date/time/venue changes that require direct communication.
Birth Date:
Please provide your Date of Birth.
RSVP Location:
1. In-Person
2. Online
*
This event is being held in-person and virtually on Zoom. Please indicate how you will attend

Audio/Video Consent:
1. I do hereby consent to the use by Eisenhower Health of my image, video, voice, or all three of them, in the Heart-to-Heart: Your Questions Answered on February 12, 2026. In addition, I waive any right to inspect or approve the finished video recording. To revoke consent, please email or telephone the simulation manager to make special arrangements. *
This event will be recorded and the recording may be reused for training or promotional purposes. To participate you must agree to the audio/video consent.
Verify:
*
Enter the text above to verify your registration

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