Webinar Registration Form

Webinar Information

Webinar Name

Target Department

Title

Webinar Start Date/Time

(None)

Country/Region & City	Webinar Start Date/Time	Registration Deadline

Moderator / Affiliation

No.	Moderator	Affiliation	Profile

Program

No.	Title	Presenter	Affiliation	Profile

Description

Webinar URL

Webinar Event Password

Webinar Documents

Invitation Image File

Registration

My Registration History

First Name *		Last Name *
	- When you participate this Zoom webinar, please type the 'SAME' first name and last name as above, for your accurate name to be shown on its certificate. - Whether or not a certificate is issued depends on the type of each webinar.
Email Address *		- If you enter WRONG email address, you will NOT receive an invitation mail or relevant document.
Confirm Email Address *
Affiliation Type *		Affiliation Name *	Affiliated Department
Job Title		Business Phone
Country/Region *		City *	Webinar Start Date/Time
Samsung Product Experience *	1. Are you a Samsung ultrasound user? (Answer Required) Yes No 2. Do you plan to replace or purchase any new ultrasound products for your department or clinic in the next SIX (6) months? (Answer Required) Yes No

Privacy Policy & Email Receipt

	Select All
Privacy Policy *	I have read and agree to the Privacy Policy (Consent Required)
Email Receipt	[Optional] I agree to receive communications via e-mail about Academic Events (Webinars, Symposiums, etc.) Newsletters (Marketing Events, Product Updates, Surveys) Transferal of my personal information and to receive communications from an authorized sales representative of Samsung Healthcare, including affiliates or business partners.

Select All

I have read and agree to the Privacy Policy (Consent Required)

Email Receipt

[Optional] I agree to receive communications via e-mail about

Academic Events (Webinars, Symposiums, etc.)

Newsletters (Marketing Events, Product Updates, Surveys)

Transferal of my personal information and to receive communications from an authorized sales representative of Samsung Healthcare, including affiliates or business partners.

Invitation Image

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