Please provide the information below to register your surgeon to attend Achieving Triple Aim Performance in an ASC Setting on March 3, 2016. You may also register one other attendee-such as the territory Sales Consultant or another HCP- to accompany your surgeon to the event. In accordance with the company's HCC policies, the other attendee must have a legitimate business reason for attending the event (e.g., no spouses, family members, etc.)
Prior to registration, you must have permission from your surgeon(s) via an opt-in or other consent to use his/her e-mail address to receive promotional and marketing materials.

If you have questions,please contact Janet Stutzman ([email protected] or 484-356-9731)
The information provided will register the surgeon and the other participant to attend the event. You, the surgeon, and other attendee will receive confirmation emails.
Surgeon's First Name
Title
Surgeon's Last Name
Practice Affiliation
Surgeon's Email
Hospital Affiliation
City
State
AVP Name
NOTE: Each surgeon may be accompanied by ONE local DePuy Synthes Companies representative.
NOTE: Each surgeon may be accompanied by ONE local DePuy Synthes Companies representative.
Other Attendee Name
Other Attendee's Position/Title
Other Attendee Email
Sales Consultant Territory #