University of Kentucky Webcast Application Form

Live Webcast - Application Form

Contact Person
First Name:
Last Name:
Organization:
Address 1:
Address 2:
Zip:
City:
State:
Country:
Phone Number:
Fax Number:
E-mail (required):

Event Information

What content are you/your institution able to provide? (check all that apply)

Live Surgery
Video Commentary
Lectures
Grand Rounds
Medical Meetings
CME courses
Resident Rounds
Other

How Often can you provide content?

How long will your event last?

City:
14. Do you trust medical information you retrieve on the Internet?(check all that apply)
ISDN 68 kbps
ISDN 128 Kbps
T1
IP
Dial up (56 kbps)
I don't know
Yes, due to presence of links for further information
I don't have anywhere else to turn for medical information
I have never used the Internet prior to this time

City:

Comments

City:

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