CF R.I.S.E. TRAINING REGISTRATION FORM Thank you for your interest in the CF R.I.S.E. program. Please take a few moments to complete the registration form below to indicate your CF center’s interest in using the CF R.I.S.E. transition program.  Upon completion of this form, you will be contacted by a member of the CF R.I.S.E. team.     Contact Information First Name :  Last Name :  Phone Number :  Email Address :        Role on the CF Care Team: -- Select --Clinical CoordinatorDietitianNutritionistNurseNurse CoordinatorNurse PractitionerPhysician’s AssistantPhysical TherapistPharmacistProgram CoordinatorPhysicianPsychologistResearch CoordinatorRespiratory TherapistSocial WorkerOther       Center Name:       Clinic Type: -- Select --AdultPediatricBoth Adult and Pediatric       CF Center Director Name:       How did you hear about CF R.I.S.E.?   A colleague   American Board of Pediatrics (ABP)   Cystic Fibrosis Foundation (CFF)   Pediatric Pulmonology   North American Cystic Fibrosis Conference (NACFC)   OneCF LLC   Other professional meeting/symposium   Other         Please indicate the days of the week/time windows that work best for you & your team to participate in a 30 minute WebEx:     Monday Tuesday Wednesday Thursday Friday

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