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12725 Louetta Road, Cypress, Texas 77429
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About Us
Staff
Services
Book An Appointment
Visit Us
Shop
Pharmacy
Merchandise
Careers
Request
Patient Portal
Doctor Speaker Request Details
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Doctor Speaker Request Details
Email Address
*
**Will CFAH products be purchased by the sponsoring organization?
Yes
No
**Will this engagement be videotaped and a copy provided to CFAH?
Yes
No
Logistics
Indicate any special needs your organization may have
Expenses
(To be covered by sponsoring organization prior to the event)
Local Events
What is mileage from Cypress, TX?
Events More Than 100 Miles
(Air travel to be secured/covered by the organization; preferences, i.e. airline, frequent flyer #, seat, flight times, etc. will be provided)
What is the length of travel time from airport to meeting place?
Ground Transportation
(To be secured/covered by organization sponsoring this event)
Please provide details of the Person Picking Up the Speaker, Car Service or Rental
Overnight Accommodations
(To be secured/covered by the organization; queen or king-sized bed, non-smoking room, and high floor preferred)
Hotel Name
Hotel Address
Street Address
Address Line 2
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Comments
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