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Registration Form
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Name of workshop:
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Your answer
Date of workshop:
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MM
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DD
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YYYY
Type / Time of the meeting or workshop:
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Live Workshop
Zoom meeting
Family name (Surname):
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Your answer
First name:
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Your answer
Academic title/Specialization:
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Country:
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Your answer
Email:
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Your answer
I am:
New to lasers/Beginner
Planning to purchase
A distributor
A current laser user
Specific questions and requests (treatments you are interested in):
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Do you use/own Fotona laser system?
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Yes
Company Name
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(for billing purposes)
Your answer
Company Address
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(for billing purposes)
Your answer
Fotona will use the information you provide on this form to be in touch with you regarding our education and to provide updates on Fotona laser products and treatments. We take our responsibility for protecting your privacy and personal data very seriously. If at any time you wish to opt-out of receiving future emails, you can simply unsubscribe by sending an email to
privacy@fotona.com
or by clicking on the unsubscribe link from any emails you have received from us. Please confirm below that you agree:
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to allow us to share your contact information with our local distributor in your country
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