Patients For Patient Safety US

First Name: *

Last Name: *

Organization Name:

Email: *

Best Contact Number: *

What portion of Project PIVOT will you attend?: *

Project PIVOT Dinner (9/14/25)

Project PIVOT Workshop (9/15/25)

All of the above

Will you attend the Congressional Briefing and/or Hill Day?: *

Congressional Briefing (9/16/25)

Hill Day (9/16/25)

All of the above

Any special needs?: *

Do we have your permission to use your picture and bio on our website?: *

YES

NO

Upload your headshot here:

Upload your bio here:

Project PIVOT Registration