Project ECHO Registration - Version 2

Thank you for your interest in our Project ECHO initiative. If you have any questions, please contact us at info@echocollaborative.org and we will respond as quickly as possible.

* : required

Facility Name:*Facility Address:*

City:*State:*Zip:*

Facility Website:

Contact Name:*Contact Title:*

Contact Email:*Contact Phone:*

Please pick the day that works best for you:* Hennepin Healthcare Training Center on Mondays from 11:30am to 1pm The University of Minnesota Training Center on Tuesdays from 12:30 to 2pm

Additional Notes or Questions:

Please complete the visual confirmation*

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