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Attendee Information Informacion del Participante
Please fill out the form completely. One form per Registrant. Copies accepted.
Por Favor, de llenar el formulario completo. Un formulario por participante. Se aceptan fotocopias.
First Name Last Name Telephone Number Fax Number
Company Name Job Title Email Address
Country
Address City State Zip or Postal Code
Business Category (check one that best describes)
Clase de Negocio (marque lo que describa major)
A. Hospital / Clinic
F. Medical Laboratory
K. Pharmacy
P. Government Agency
B. Imaging Center
G. HME /DME Provider
L. Sub-Acute Care / Nursing Service
Q. Press
C. Integrated Medical Delivery Network
H. Insurance Services HMO / MCO / PPO
M. Long Term Care Facility
R. Technology Provider
D. Group Purchasing Organization
I.
E. Private Medical Practice
J. Manufacturer - Medical Products
O. Financial Services
A. Owner / President / CEO
F. Clinical Engineer
K. Operations Manager
B. General Manager
G. Imaging Equipment Specialist
L. Sales Manager
C. Physician
H. Biomedical Engineer
M. Information Technology
D. Director
I.
E. Purchasing Manager
J. Marketing Manager
Hospitale / Clinica
Laboratorio Medico
Centro de Imagen
Laboratorio Medico
Proveedor de HME/DME
Red Integrada de Asistencia Medica
Cuidos Especializados /Enfermeria
Proveedor de HME/DME
Organizacion de Compras
Sector Privado-Medicina
Agencia del Gobierno
Distributor of Medical Products
Instalacion de Cuidado a Largo Plazo