Philips SPECT/CT Symposium Registration

Thank you for registering for the 2010 Philips SPECT/CT Symposium. After completing this form, click submit and you will receive an email confirmation of your registration. If you have any questions or experience any problems, please contact Shelly Todd by email(Shelly.Todd@philips.com) or telephone (408) 458-0595.
We look forward to seeing you at the event.
* Indicates required field.

PERSONAL INFORMATION
Salutation Professor Doctor Mr. Mrs. Ms
* First Name
*Last Name
Position/Title
Occupation
Company/Institution
Department
Hospital/Clinic
*Address
Address 2
*City
*Post/Zip
*Country
Telephone
Fax
*Email
*Email Again

QUESTIONS

* 1. Which show are you registering for?

2. How did you hear about the event? (Check all that apply)
Email
Philips website
Colleague
Philips representative
Other

3. Current SPECT or SPECT/CT system? (Check all that apply)
Philips Brightview
Philips Precedence
Philips Skylight/Forte/Vertex
Philips Prism/Axis/Irix
No SPECT or SPECT/CT system
Other system

4. If other, please specify

5. Which clinical areas are you interested in? (Check all that apply)
Cardiac
Neurology
Bone imaging
Oncology
Infection imaging

6. Please include me on the email list for notification of future Philips Nuclear Medicine events
Yes
No

Submit
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