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ONLINE EVENT REGISTRATION & PAYMENT

Corks & Forks Event Registration

 
$
$
Credit or Debit Card (Processed by Paypal - Does not require a Paypal account.)
National Capital Physicians Foundation
15855 Crabbs Branch Way
Rockville, MD 20855
National Capital Physicians Foundation
15855 Crabbs Branch Way
Rockville, MD 20855
p: 301.921.4300 
f: 301.921.4368
info@dedicatedtohealth.org
Executive Director:  Susan G. D’Antoni
Program Coordinator:  Karissa Miller
Accounting Manager:  Veena Sarin
 
Executive Director:  Susan G. D’Antoni
Program Coordinator:  Karissa Miller
Accounting Manager:  Veena Sarin
 
NOTE: THIS PROGRAM IS NOT FOR PHYSICIANS IN CRISIS.
If you are in crisis, call 911 or go to the nearest Emergency Room.
 
The Physicians’ Resource Network is an early intervention counseling program to help physicians achieve greater resilience and balance in their professional and personal lives.

When this form is received, you will be contacted within 24-36 hours to confirm an appointment.

All fields must be completed or the form cannot be submitted.