Request an online focus group session using the form below. Your request will be submitted and reviewed by the AEHIA Foundation staff who will be in touch with your request status within 1-2 business days. Point of ContactName* First Last Title* Foundation Organization* Email* Phone*Focus Group DetailsPlease choose three (3) desired dates and times at 2pm EST*Date/Time 1Date/Time 2Date/Time 3 Online Focus Groups are only held on Tuesday, Wednesdays or Thursday either at 2pm EST. Example: 5/25/19 at 2pm EST. Please note these are subject to availability.Title* Abstract*Speaker InfoSpeaker 1Name* First Last Credentials Organization* Title* Email* Speaker InfoSpeaker 2 (if applicable)Name First Last Credentials Organization Title Email