Salutation Dr. Prof. Assit. Prof Consultant Dr. Med. Ds. Fellow Mr. Mrs. Ms. Post Graduate Year (PGY) Resident

First Name

Last Name

Profession Administrator BioMed Engineer Buyer / Procurement / Purchaser Cardiologist Cathlab Technician Clinical Engineer Gastroenterologist Gynecologist Hepatologist Interventional Radiologist IT Nurse Nurse Practitioner Oncologist Other Pharmacist Physician Radiographer Radiologist Radiotherapist Radiotherapist (Sonographer) Researcher or PhD Resident Surgeon Technician Urologist Veterinarian

Speciality Abdominal Angiography Breast Imaging Cardiac Imaging Cath Lab CT Emergency Fertility Gastroenterology Head & Neck Image-guided Tumour Ablation Interventional Cardiology Interventional - General Interventional - Neuroradiology MRI Musculoskeletal Neuroradiology Nuclear Medicine Other Pain Pediatric PET  Radiation Oncology Radiology - General Spine Thoracic Thyroid Ultrasound Urogenital

Product Interest Cath Lab Injector Contrast and Care CT Injector Digital Liver Care Dose and Care Dotarem Duonco Bone Lesions Duonco Liver Duonco Pancreas Elucirem™ Gadoteric Acid Icobrain Lipiodol® in HSG Lipiodol® in Liver Lipiodol® in Lymphography Lipiodol® in Vascular Embolization MR Injector Myrian Suite Myrian XP Lung Nodule AI Myrian XP Prostate AI Oncology Assistant Optiray Patent Blue V in Sentinel Nodes Identification Syringes and Consumables Technical Services UNIK Urology Xenetix

Organization

Country United States Canada Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d’Ivoire Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong S.A.R., China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Viet Nam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe

Zip

Email

I agree to subscribe to email communications such as educational or event invitation from Guerbet and its affiliates

I want to be contacted by a sales representative

Comments

Your personal data will be processed by Guerbet in order to send you the document. For this purpose, Guerbet may transmit them to its affiliates and authorized third-parties. The legal basis for processing your personal data is your consent. They will be stored until you withdraw your consent using the unsubscription link found at the bottom of Guerbet’s emails. You have the right to request access, rectification or erasure on your personal data and to request restriction of processing by contacting Guerbet at  diagnostic.imaging(a)guerbet-communication.com. You have the right to lodge a complaint with data protection authorities if you consider that your personal data are processed in breach of the applicable law.