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First name:
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Last name:
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Email Address:
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Retype Email Address:
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Phone number:
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Company Name:
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Job title:
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Business/Facility Address:
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Business/Facility Address 2:
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City:
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State:
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Country:
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Zip/Postal Code:
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What is your current role in the pathology field?
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Pathologist
Lab manager/director
Laboratory technician
Researcher
Pathology Assistant
Other
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If you answered 'other' above, please specify your role in the pathology field:
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In what kind of lab/practice do you work? (Please select all that apply)
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Community hospital
National reference lab
Regional reference lab
VA hospital
Academic Medical Center
National Cancer Institute (NCI)
Research
Other
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If you answered 'other' above, please specify the kind of lab/practice where you work:
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Are you currently using digital pathology in your daily work?
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Yes
No
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Yes, I acknowledge that Thermo Fisher Scientific Inc. and suppliers will process my provided information and that I may receive communications
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