Medical Automation [Healthcare for the future]

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Online Registration

Step 1 of 3

Complete Registration Information

*First Name
Middle Initial
*Last Name
Credentials
*Job Title
*Business /Organization
*Email (most information will be sent via email)
*Business Address
*City
*State/Province
*Zip/Postal Code
*Country
*Business Phone		eg. +1-202-405 4371
Mobile Phone
Fax

*Do you require special assistance because of a handicap or disability, or have any dietary restrictions?
Yes No
If yes, describe:		not more than 200 words
NOTE: If you are registering later than, November 26, to guarantee that your needs are met, send an email to conferencemanager@medicalautomation.org describing your needs.

Dietary requirements		None Vegetarian Other

*How did you first hear about this conference?
	Email announcement
	Invitation
	From a colleague
	From a company representative - Which company?
	Searching the website
	Link from another website - Which website?
	Other –

Please Enter Your Promotional Code if Provided