Personal Information

Fill out the information below, then click Next to continue.

To register for this Cook Medical event, please provide your information in the form below so that we can arrange your attendance and communicate with you about the event. Please review our Data Protection Notice for Events to learn how we collect and process your personal data.

The information shared at this event may include confidential business information and personal data. Therefore, only the host is permitted to record a Cook event, and we reserve the right to record any event. Recording of this event by participants is not permitted by any means, including recording audio or video, photography, screen capture, or other copying methods. When the event is being recorded, participants will be informed at the beginning of the event. By registering for the event, you are confirming you will not record the event in any way.

Registration Type

HCP Attendee - AMER

Additional Information

* 

Do you currently use a high power laser in your facility?

This question is required.
* 

1. Do you have access to the necessary equipment needed to perform HoLEPs? (Ie. Morcellator, Scopes, Video Towers, etc)

This question is required.
* 

1. Have you performed a HoLEP in the past? 

This question is required.

How many have you performed?

* 

1. Do you want to us to contact you with additional information about HoLEP proctoring? 

This question is required.
* 

How were you informed of this course?

This question is required.