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VIRTUAL EVENT SUBMISSION
Please Name the Device/Manufacturer (i.e. Sofwave, CoolSculpting, ellacor, etc)
Manufacturer Rep/BDM Full Name
Rep Email
Rep Phone
What is the name of the business/practice you are submitting (i.e. ABC Dermatology)
Account/Practice Website
Event Main Contact Full Name
Event Contact Email
Event Contact Phone
Second Event Contact Full Name
Event Contact 2 Email
Event Contact 2 Phone
Additional Information
SUBMIT INFO TO AIG
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