Registration: Advanced SPECTRALIS Hands-On Operator Course

Title*

First Name*

Last Name*

Email*

Phone number*

Company / Practice*

Mailing Address*

City*

ZIP*

State / Province*

Country*

Dates

SPECTRALIS OCT Hands-On Operator Course*

Please indicate if your SPECTRALIS System has a touch panel:*

Agreement*

I agree that Heidelberg Engineering GmbH may transfer this data solely for the purpose of processing my registration to the distribution partner Heidelberg Engineering Inc.. Heidelberg Engineering Inc. is the fully owned subsidiary of Heidelberg Engineering GmbH in United States and processes data in compliance with local data protection laws and regulations. I confirm that I have read and accept the privacy policy. I understand that I can object to the use of my personal data with future effect at any time. I can address a revocation directly to the contact data stored in the privacy policy.

With * marked fields are obligatory.

SPECTRALIS OCT Hands-On Operator Course*

Price: $295.00 Quantity:

Total

$0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name