Registration Form
For questions, please email us at info@ccmregistry.org
*
indicates required fields
*
Name:
*
Gender:
Male
Female
*
Background:
Physician
Hospital Administrator
Government
Media
Industry
*
Name of Organization:
*
Address:
Degree:
MD
PhD
MS
BS
Title:
*
Telephone:
Fax:
*
Mobile:
*
Email:
Registration Fee:
Industry USD 100 (RMB 600)
Non industry Free
Payment Method:
Pay by credit card
Pay by wire transfer
Pay by cash on site
How did you hear about this event?:
Internet
Employer
Friend
Is your organization a sponsor of this event?:
Yes
No
Is you organization a sponsor of CCMR?:
Yes
No
Would you like to learn more about sponsorship?:
Yes
No
Remarks:
Please click on the SUBMIT button to advance to the next step.
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