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Please complete all fields marked with an asterisk, as these are required for program registration.

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Last Name *

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Primary Practice Name *

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I attest that my job responsibilities are directly involved in Patient Care, as that term is defined by Dompe.

Yes

Branded Program Attestation: I understand that I am attending a Dompe-sponsored Oxervate speaker program regarding the diagnosis of NK and its treatment of Oxervate. I attest that I have an educational need to receive the content of, and participate in, this speaker program based on my job responsibilities (including, for non-prescriber staff, my role-based need for the content), the specialty and patient population of my practice, and my level of familiarity with NK. To the best of my knowledge, I have not previously attended a Dompe program on the same or substantially similar content.

Yes

Disease State Program Attestation: I understand that I am attending a Dompe-sponsored speaker program focused on the NK disease state, including its pathophysiology and diagnosis. I attest that I have an educational need to receive the content of, and participate in, this speaker program based on my job responsibilities (including, for non-prescriber staff, my role-based need for the content), the specialty and patient population of my practice, and my level of familiarity with NK. To the best of my knowledge, I have not previously attended a Dompe program on the same or substantially similar content.

Yes

Program Details

Program #: 30456

Date: 10/08/2026

Time: 6:00 PM

Speaker: Douglas Devries

Rep Name: Amy Romano

Rep Phone:

Venue

Venue Name: Palio Restaurant

Address 1: 640 Sacramento Street

Address 2:

City: San Francisco

State: CA

Zip: 94111

Dompe U.S. Inc. Speaker Programs are intended for U.S. accredited Health Care Professionals only. Attendance is not open to the public.
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