The following information is requested to help
us design the course for the people who will actually be using it. Please send this form,
even if you already indicated your interest by email to Dr. Perry; these new forms
will go directly into a database.
IF your browser does not handle "forms" (i.e., it won't let you fill in the
blanks), you may still be able to PRINT it now and either FAX it to 305-294-5115, or
convert it to an email message and send to DrPerry@incontinet.com.