Round Table Registration

Registration for Round Table (10/28/2011)
Please contact us at info@vitalstrategic.com, if any issue with the registration.

*indicates required fields

*Name:

*Gender:

Male
Female

*Organization:

*Organization Type:

Multi-national Industry
Domestic Industry
Hospital
Academic
Other

*Title:

*Office Phone #:

*Mobile Phone #:

*Email Address:

Office Address:

*Why are you interested in Registry?:

*Conducted any registry within last 3 years?:

Yes
No

If yes, what disease area?:

If yes, paper or EDC based?:

Paper based
EDC based or mix

*Plan to conduct any registry in China?:

Yes, Please explain your plan
No, Please explain reason

IPlease briefly explain:

*Registration Type:

Individual (800 RMB or $120 USD))
Organization (1500 RMB or $230 USD）)

*Payment Type:

Please click the "SUBMIT" button after you complete the form.

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