Registration Form for Weight Loss Surgery Information Session

Visit the Center for Weight Loss Surgery for more information about our program and our doctors.

Event Information

Event Title	Weight Loss Surgery Seminar with Dr. Choi
Location	Danbury Hospital Robilotti Center
Start	April 13, 2010 5:30
End	April 13, 2010 8:00
Fee	0.00 - This is a free event

Your Name*
Your Email*
Your Phone*
Your Address
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Comments
What heath insurance provider do you have? Please include the name of the plan if you know it.
When is your birthdate? *

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