€191.00
Salutation *
First Name *
Last Name *
Job Title *
Organization *
Contact email *
Phone
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From time to time, ICHOM may wish to contact you regarding products and services from other organisations which we think may be of interest to you. Do you wish to be contacted? Yes No
May ICHOM send you information via email to share how ICHOM is collaborating with people across the globe to advance healthcare to outcomes most valued by patients? Yes No
From time to time, ICHOM may use your name, job title and organization for networking purposes. Please tick this box if you do not wish for us to do so. Yes No
Do you wish to find out more about becoming a sponsor of the ICHOM Conference Series? Yes No
What other events do you attend throughout the year? (If none, put none)
Are you a member of a healthcare association? Please list all memberships
Please choose what best describes your expertise / interest?* Choose an option * Oncology Muskoskeletal Cardiometabolic Maternal - Child Health Mental Health Ophthalmology Life-course Other
Has your organization implemented ICHOM Sets of Patient-Centered Outcome Measures?* Choose an option * Yes, we have implemented one or more ICHOM set(s) We are in the process of implementing No, we have not implemented ICHOM Sets
Which category best describes your organization?* Choose an option * Provider of Healthcare Industry (Other) Industry (Pharma) Industry (MedTech) Charity Academic Patient / Patient Group Government Regulatory Body / Professional Bodies / Associations
